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LECTURES 


•ON- 


Principles  oP  Osteopathy, 


BY- 


GHAS.  HAZZAl^D,  PH.  B.,  D.  0. 

Lecturer  on  Priiuii)les  of  Osteopathj'.  American  Scliool 
of  Osteopathy.  Kirksville.  3Io..  1898. 


KIRKSVILLE,  MO., 
ADVOCATE  BOOK  AND  JOB  PRINT, 
1898. 


COl’YEIGHT.  1898,  BY  CHAS.  HAZ-ZARD,  D.  (). 


THE  FLOWERS  COLLECTIOS 


L / r,  1k 

h ^3/  ^ 


PREFAGE. 


The  following  lectures  were  reported  bj'  the  arrangement  and  for  the 
convenience  of  the  members  of  my  class;  being  printed  and  distributed  to 
the  students  in  the  form,  merely,  of  students’  notes.  The  students  saw  fit  to 
bring  them  out  in  bound  form  for  the  sake  of  preservation.  Their  distribution 
has  been  strictly  limited  to  the  students  of  the  American  School  of  Osteopathy, 
hence  the  little  volume  is  to  be  considered  only  as  one  of  students’  notes,  and 
in  no  sense  as  a published  work. 

CHAS.  HAZZARD. 

Kirksville,  Mo.,  April  16,  1898. 


49Gei3 


4 


LECTUKE  I. 

I.  GENERAL  CONSIDERATIONS. 

Learn  to  treat  understandingly ; imitate  no  operator’s  motions.  Emerson 
says,  “Imitation  is  suicide.”  Take  for  instance  a case  of  erysipelas.  Should 
the  operator  treat  about  the  sore  spots,  occuring  usually  on  one  side  of  the 
face  near  the  ear,  and  treat  there  alone,  without  giving  attention  to  the  general 
conditions  of  the  patient,  taking  into  account  the  affections  of  the  kidneys,  liver 
and  other  organs,  in  this  trouble  he  would  certainly  not  meet  with  success.  One 
must  understand  the  nature  of  the  disease  which  he  is  treating. 

Make  a correct  diagnosis  of  the  case.  There  are  no  two  eases  alike.  You 
cannot  take  it  for  granted  that  one  case  which  you  receive  to-day  is  like  the  case 
which  you  treated  yesterday.  Look  over  the  case  thoroughly’  making  an  in- 
dividual diagnosis  for  it;  likeness  and  unlikeness  to  other  cases  are  incidental 
only.  Make  no  diagnosis  by  telephone,  as  I knew  a physician — a fellow  towns- 
man of  mine — to  do  once.  Remember  that  a young  doctor’s  success  often  de- 
pends upon  how  he  handles  a simple  case.  For  instance  headache,  which  al- 
though not  always  simple,  is  frequently  so.  Should  you  be  called  lirst  upon  a 
case  of  headache  and  treat  it  successfully,  granting  it  was  a simple  case,  your 
future  success  in  that  town  in  which  you  may  be  located,  may  depend  upon 
that.  I may  cite  here  an  incident  told  of  Thoreau.  It  is  said  that,  traveling 
upon  a train  one  day  he  had  occasion  to  lower  the  car  window ; soon  thereafter 
he  was  accosted  by  a manufacturer  traveling  upon  the  same  train,  who  said  he 
had  noticed  his  delicate  manipulation  of  that  window  and  upon  the  strength  of 
that  observation  offered  him  a position  in  his  manufactory. 

Have  your  theories,  but  stick  to  facts.  Remember  that  you  cannot  always 
treat  a ease  according  to  preconceived  theories — that  each  case  is  peculiar  to 
itself.  Huxley  says,  “Theories  do  not  alter  facts,  and  the  universe  remains 
unchanged,  even  though  texts  crumble. 

II.  GENERAL  CONSIDERATION  OF  THE  SPINE. 

Origin  of  the  Spinal  Nerves,  (Holden)  : “The  origin  of  the  eight  cervical 

nerves  corresponds  to  the  interval  between  the  occiput  and  the  6th  cervical 
spine. 

“The  origin  of  the  first  six  dorsal  nerves  corresponds  to  the  interval  be- 
tween the  6th  cervical  and  the  4th  dorsal  spines. 

“The  origin  of  the  lower  dorsal  nerves  corresponds  to  the  interval  between 
the  4th  and  11th  dorsal  spines. 

“The  origin  of  the  five  lumbar  nerves  corresponds  to  the  interval  between 
the  11th  and  12th  dorsal  spines. 

“The  origin  of  the  five  sacral  nerves  corresponds  to  the  last  dorsal  and 
first  lumbar  spines.” 


Laadmarks  along  the  spine : Holden  instances  a median  furrow  caused 

by  the  prominences  of  the  erectors  spinte,  which  extend  along  the  spine  as  far 
as  the  interval  between  the  5th  lumbar  vertebra  and  the  sacrum.  Hollows  upon 
the  sui’faee  correspond  generally  to  prominences  of  the  skeleton,  and  vice  versa. 
This  is  on  account  of  the  attachments  by  tendons  to  prominent  skeletal  points. 
Sharp  friction  will  redden  the  spines  of  the  vertebrte  so  that  they  can  be  count- 
ed and  notice  whether  they  are  in  line  or  not.  The  level  of  the  3d  dorsal  spine 
is  the  level  of  the  beginning  of  the  spine  of  the  scapula. 

The  level  of  the  7th  dorsal  spine  corresponds  to  the  inferior  angle  of  the 


The  level  of  the  12th  dorsal  spine  corresponds  to  the  head  of  the  last  rib. 

The  level  of  the  3d  costal  space  corresponds  with  the  root  of  the  spine  of 
the  scapula. 

The  level  of  the  3d  dorsal  spine  corresponds  with  the  3d  intercostal  space. 

The  level  of  the  3d  intercostal  space  corresponds  with  the  level  of  the 
right  and  left  bronchi,  the  right  being  nearer  the  posterior  chest  wall. 

The  following  is  a convenient  method  for  ascertaining  the  position  of  the 
12th  dorsal  spine:  Have  patient  fold  his  arms  and  lean  forward,  thus  bringing 

the  spines  of  the  vertebrie  out  prominently ; then  the  lower  border  of  the  trap- 
ezius muscle  can  be  traced  to  the  I2th  dorsal  spine. 

The  kidney  is  best  reached  by  pressure  below  the  level  of  the  last  rib  at  the 
outer  edge  of  the  erector  spinee. 

The  tip  of  the  crest  of  the  ilium  is  about  the  level  of  the  spine  of  the  4th 
lumbar  vertebra. 

The  ilio-costal  space  extends  from  the  lower  borde'r  of  the  12th  rib  to  the 
crest  of  the  ilium,  varying  in  width  from  the  width  of  a finger  to  that  of  a 
hand.  So  says  Holden.  I would  caution  you,  however,  in  the  former  case  to 
ascertain  carefully  whether  or  not  there  be  a dropping  of  the  ribs  and  altera- 
tion of  the  chest  in  its  autero-posterior  diameter.  Such  a condition,  a narrow 
ilio-costal  space,  is  usually  accompanied  by  neurasthenia  and  kindred  affections 
in  the  patient. 

In  the  depression  below  the  occiput  are  found  the  edge  of  the  trapezius 
muscle  and  the  upper  end  of  the  ligamentum  nuehm. 

The  2nd  cervical  spine  is  forked  and  rather  prominent.  The  3d,  4th  and 
5th  cervical  spines  are  not  usually  made  out,  as  they  recede  anteriorly  from 
the  surface.  The  6th  and  7th  (prominens)  are  prominent.  The  spines  of  the 
dorsal  vertebrie  correspond  with  the  heads  of  the  ribs  next  above,  e.  g.,  the 
4th  dorsal  spine  with  the  head  of  the  3d  rib.  But  the  11th  and  12th  dorsal 
spines  correspond  with  the  heads  of  those  ribs. 


In  the  location  of  the  atlas,  it  is  felt  only  by  making  out  its  transverse 
processes,  which  are  readily  felt  on  each  side  between  the  mastoid  process  and 


scapula. 


III.  ILLUSTRATIONS  UPON  THE  SPINE 


3 


the  angle  of  the  inferior  maxillary  bone;  the  normal  position  being  about  mid- 
way between  these  points  on  either  side.  Should  there  be  a deviation  from 
the  normal,  either  to  one  side  or  the  other,  anteriorly  or  posteriorly,  or  a twist 
in  either  direction,  it  is  readily  made  out  by  the  trained  touch. 

Peculiar  vertebrm  are  found  along  the  spine,  viz. : the  2nd,  6th  and  7th 
cervical,  I2th  dorsal  and  5th  lumbar.  The  2nd  cervical  is  noticeable  because 
of  being  slightly  prominent  and  bifid.  The  6th  and  7th  cervical  because  of 
slight  prominence.  The  I2th  dorsal  because  it  often  marks  what  the  Osteopath 
calls  a “break,”  a separation  of  the  spines  of  the  vertebrae  occuring  between 
the  12th  dorsal  and  1st  lumbar.  This  is  a point  of  importance.  The  same  is 
the  case  with  the  .5th  lumbar,  there  often  being  a break  between  its  spine  and 
the  superior  crest  of  the  sacrum. 

The  ligamentum  nuchae  is  of  great  importance  to  the  Osteopath.  You  will 
remember  that  it  extends  from  the  occipital  protuberance  to  the  7th  cervical 
spine.  You  must  learn  to  recognize  it  by  touch.  Frequently  it  will  contract 
and  is  the  sole  means  of  relieving  headache  when  stretched. 

HOW  TO  EXA3I1NE  A SPINE. 

In  the  first  place,  notice  if  at  any  point  along  the  spinal  column  the  spine  of 
any  vertebra  is  deviated  laterally.  In  such  a case  there  is  usually  a sore  spot 
in  the  muscles  upon  the  side  of  the  spine  toward  which  it  is  deviated.  In  the 
neck  we  do  not  depend  upon  the  prominences  of  the  spines  behind,  to  diagnose 
a slip  in  the  vertebrae,  but  by  turning  the  head  to  one  side,  thus  bringing  into 
prominence  the  transverse  processes  of  the  vertebrae,  we  may  ascertain  whether 
or  not  one  is  prominent  anteriorly  or  posteriorly ; in  such  a case  a sore  spot 
usually  is  found  at  the  end  of  the  transverse  process  of  the  vertebra.  Spines 
may  be  separated  at  any  point  along  the  column  ; you  maj^  find  the  spines  ab- 
normally far  apart.  We  occasionally  find  what  is  designated  a smooth  spinal 
column,  by  which  I mean  that  a spinal  column  may  have  its  vertebrm  so  pro- 
tected by  the  thickening  of  the  ligaments  or  other  structures  as  to  obviate  the 
ordinary  feeling  one  experiences  in  running  the  hand  down  the  spine.  For 
such  a condition  I have  somewhat  arbitrarily  adopted  the  term,  “a  smooth  spinal 
column.”  The  natural  curves  of  the  spine  may  be  changed,  as  will  readily  be 
observed  by  you  in  practice.  I do  not  speak  here  of  spinal  curvatures,  not  at 
all ; but  frequently  a slight,  or  it  may  be  a marked,  deviation  from  the  natural 
curve  described  by  the  normal  spinal  column,  will  be  noticed.  Hence,  if  there 
is  a break,  ligaments  often  cause  lesions  in  that  they  may,  by  the  displacement 
of  the  bon3^  parts  to  which  they  are  attached,  be  dragged  across  some  important 
structure,  such  as  a nerve  or  a blood  vessel,  thus  compressing  it  and  abridging 
its  function. 

These  points  upon  how  to  examine  a spine  will  be  continued  in  further 
lectures,  and  their  significance  to  the  Osteopath  be  fully  considered  at  those 
times. 


4 


LECTUEE  II. 


1.  Centers  OF  THE  Sympathetic: — These  centers  are  of  vast  import- 
ance to  the  Osteopath.  Eeasoning  according  to  centers  is  frecpiently  with 
him  going  from  effect  back  to  cause,  and  of  course  from  periphery  back  to 
center.  It  instances  one  of  his  modes  of  thought;  and  to  acquire  this  habit  of 
mind  and  of  thought  is  frequently  the  basis  of  our  professional  success.  There 
is  a given  definite  center  for  the  activities  of  a given  point  or  organ.  For  in- 
stance, there  is  a center  upon  which  we  work  to  affect  the  kidney:  or,  we  may 
say  there  is  a given  definite  center  for  each  physiological  process.  As  for  in- 
stance, there  is  a center  upon  which  we  work  to  affect  the  general  cii’culation. 
In  the  absence  of  a discoverable  lesion,  which  frequently  occurs,  the  Osteo- 
path’s work  must  be  largely  on  the  centers,  sometimes  entirely  so.  Even 
when  the  lesion  has  been  found  and  attended  to,  he  must  give  much  attention 
to  the  particular  center  governing  the  part  affected.  Eemember,  it  is  going- 
back  to  first  principles.  I would  beg  you  to  remember  that  the  following 
points  have  been  gathered  from  various  sources;  from  the  experience  of 
operators,  from  lectures  heard  from  others,  from  books,  from  conversations, 
from  my  o-wn  personal  experience,  and  that  I cannot  in  every  case  give  you 
the  authority  for  the  center  designated.  I speak  of  the  centers  more  in  an 
Osteopathic  than  in  a pui-ely  physiological  sense,  meaning  that  point  along 
the  spine  which  has  designated  itself  as  a center  in  response  to  the  work  upon 
it;  results  justify  such  statements.  In  other  cases,  of  course,  these  so-called 
centers  are  the  physiological  centers  indicated  by  the  authorities. 

Centers  of  the  Sympathetic.  (For  the  folio-wing  centers  I am  especially 
indebted  to  Drs.  Alice  Patterson  and  C.  P.  McConnell.): 

Third  cervical  vertebra,  middle  of  neck.  Above,  maniinilate  upward; 
below,  downward. 

Third,  fourth  and  fifth  cei’-vLcal,  origin  of  the  phrenic — hiccoughs. 

Third,  fourth,  fifth  and  sixth,  vaso  motors.  The  superior  cer-vical 
ganglion  is  connected  with  the  first  to  fourth  cervical  nerves.  This  ganglion 
lying  opposite  the  second  and  thii-d  cervical  vertebrse.  The  middle  cer-vical 
ganglion  connected  with  the  fifth  and  sixth  cer-vical  nerves;  this  ganglion 
lying-  opposite  the  sixth  and  seventh  cervical  vertebne. 

The  point  betv'een  the  first  and  second  dorsal  vertebrae,  the  center  to  the 
lungs. 

First  rib  for  heart  flutter. 

Between  second  and  third  dorsal,  ciliary  center,  and  recti  of  the  eye 

ball. 

Between  fourth  and  fifth  dorsal  on  right  side  for  the  stomach  center;  on 
the  left  the  pneumogastric  for  the  pyloric  orifice. 

Fifth  and  sixth  dorsal,  vaso  motors  to  the  arm. 


5 


Fifth,  sixth,  seventh  and  eighth  dorsal,  great  splaehnics. 

Eighth  dorsal,  center  for  chills. 

Between  eighth  and  ninth  dorsal,  center  for  liver. 

l^inth,  tenth  and  eleventh  dorsal,  small  splaehnics. 

Twelfth,  smallest  splachnic. 

From  a point  between  the  seventh  cervical  and  first  dorsal  to  a point  be- 
tween the  eighth  and  ninth  dorsal,  the  center  for  the  anterior  dorsal  branches 
which  convey  dorsal  branches  to  pulmonary  center.  The  ijosterior  pulmonary 
plexus  connects  with  the  second,  third  and  fourth  ganglia  of  the  sympathetic. 
The  anterior  pulmonary  plexus  from  the  pneumogastric  and  the  sympathetics. 
Vaso  motors  to  the  lungs  have  been  found  in  the  dog  from  the  second  to  the 
seventh  dorsal.  This  corresponds  to  the  centers  upon  which  we  work  in  man 
to  reach  the  lungs. 

Second  lumbar  vertebra,  center  for  parturition,  micturition,  defecation. 

Third  lumbar,  coeliac  axis. 

Point  between  fourth  and  fifth  lumbar  vertebne,  defecation. 

Fifth  lumbar,  center  for  hypogastric  plexus. 

From  a point  between  the  second  and  third  sacral  to  a point  between  the 
fourth  and  fifth  sacral,  center  for  the  neck  of  the  bladder. 

Fourth  sacral,  center  to  relax  vagina. 

Fifth  sacral,  sphincter  ani  (the  latter  two  are  spinal  branches.) 

The  term  “cervical  brain”  has  been  applied  by  Dr.  Still  to  the  region 
lying  between  the  first  cervical  vertebra  and  the  fourth  dorsal  vertebra.  The 
term  “abdominal  brain,”  has  been  applied  by  him  to  the  region  lying  be- 
tween the  first  dorsal  and  third  lumbar  vertebire.  Pelvic  brain,  to  that  re- 
gion lying  between  the  tenth  dorsal  and  fifth  lumbar  vertebrte. 

Other  centers  of  the  sympathetic  are  as  follows: 

Sensation,  atlas  to  fourth  dorsal. 

Motion,  fourth  dorsal  to  sixth  dorsal. 

Nutrition,  sixth  dorsal  to  coccyx. 

These  three  centers  are  spoken  of  by  Dr.  Still,  not  fully  understood  by 
me,  and  are  still  food  for  thought. 

Centers  in  the  medulla  as  follows:  Cough,  sneeze,  vomit,  respiration, 

salivation,  phonatiou  and  deglutition,  renal  center,  center  for  spasms. 

Vaso  motor  centers:  Medulla,  second  to  sixth  dorsal,  fifth  lumbar. 

(I  remember  once  when  sent  to  attend  a case  of  Dr.  Hildreth’s,  his  words 
tomewei’e,  “Eeduce  the  fever  by  desensitizing  in  the  superior  cervical 
ganglion,  the  middle  dorsal,  and  the  lower  lumbar.”) 

Cilio-spiual  center,  fifth  cervical  to  the  second  or  fourth  dorsal. 

To  dilate  the  iris  and  contract  the  pupil,  from  fifth  cervical  by  the  su- 
perior cervical  ganglion. 


6 


Heart  center,  in  the  corpora  striata;  first  rib;  first,  second,  third,  fourth 
and  fifth  dorsal  vertebrse. 

Parturition,  second  lumbar  vertebra. 

Cervix  uteri,  ninth  dorsal. 

Blood  supply  to  ovaries,  eleventh  dorsal. 

Uterus,  second  lumbar,  second  and  third  cervical  vertebrm,  also  from 
hj^iogastric  jilexus  by  the  lower  dorsal  and  four  upper  lumbar  nerves  and 
through  the  splachnics. 

Yaso  motors  of  the  head:  The  eye,  ear,  salivary  glands,  tongue,  brain, 

etc.,  are  all  reached  at  the  superior  cervical  ganglion.  Here  also  a general 
vaso  motor  effect  to  the  body  is  claimed.  Vaso  constrictors  for  the  head  are 
said  to  exist  at  the  fifth  and  sixth  dorsal  vertebrae.  Stimulation  of  the  su- 
perior cervical  ganglion  has  a vaso  constrictor  effect  uijon  the  vessels  of  the 
retina,  probably  through  its  ascending  branch  and  its  connection  with  the 
fifth  nerve. 

The  lungs,  second  to  seventh  dorsal  vertebrae. 

Jejunum,  first  to  fifth  dorsal  vertebrae. 

Small  intestine,  above  first  lumbar. 

Large  intestine,  first  to  fourth  lumbar. 

Liver,  from  the  splachnics,  vagi,  and  inferior  cervical  ganglion. 

Kidneys,  at  the  sixth  dorsal,  second  lumbar,  renal  splachnics  and  super- 
ior cervical  ganglion. 

Spleen,  splachnics  on  the  left  side,  eighth  to  twelfth  dorsal. 

Lower  limbs,  second  dorsal  down. 

Circulation,  suijerficial  fascia  (the  second  dorsal  for  the  upper  part  of 
the  body,  the  fifth  lumbar  for  the  lower  part. ) 

Valves  of  the  heart,  second  to  fourth  dorsal. 

Ehythm  of  the  heart,  third  and  fourth  cervical. 

The  genito  spinal  center  and  the  lower  hypogastric  plexus  and  plexus  to 
intestinal  canal,  bladder  and  vasa  deferentia,  at  the  fourth  and  fifth  lumbar. 

Bowels,  peristalsis,  ninth,  tenth  and  especially  the  eleventh  dorsal. 

Larynx,  first,  second  and  third  cervical. 

III.  Howto  Examine  a Spine.  (Continued.) — Look  for  the  lesion 
always.  It  may  be  high  above  or  much  below  the  usual  center.  For  in- 
stance, we  may  work  as  high  as  the  lower  dorsal  for  sciatica,  its  center  being- 
in  the  sacral  plexus.  This  lesion  may  be  in  the  nature  of  a strain,  congested 
muscle,  a dragging  of  ligaments,  a tightening  of  the  ligaments,  thus  drawing 
the  vertebrae  together.  It  may  be  in  the  nature  of  a sprain  or  break.  It 
may  even  be  absent.  But  remember  that  your  dut^^  is  not  done  until  you 
have  thoroughly  looked  for  the  lesion.  A congestion  of  the  spinal  muscles  is 
often  noticed  on  examination;  it  may  be  of  the  superficial  muscles  or  of  the 
deep  muscles;  it  may  be  iirimary  or  secondary.  By  primary,  I mean  a con- 


gestion  to  the  muscles  set  up  hy  some  direct  effect  upon  them,  e.  g.  the  effects 
of  a draft  or  a blow.  This  congestion  involves  the  peripheral  termination  of 
the  spinal  nerves,  acting  through  them  and  through  their  sympathetic  con- 
nections to  affect  some  internal  viscus.  By  secondary,  I mean  the  reverse, 
for  example,  the  stomach  may  be  affected,  and  the  effects  may  be  transmitted 
over  the  solar  plexus  back  along  the  splachnics  thence  to  the  spinal  nerves 
with  which  the  splachnics  are  connected,  thence  back  over  the  peripheral  ter- 
minations of  these  nerves  to  the  skin  and  muscles  of  the  back.  You  may,  in 
your  examination  of  the  spine,  find  that  it  is  frequently  rigid,  not  pliant:  on 
the  other  hand,  you  may  find  that  it  is  quite  relaxed;  abnormally  mobile. 


LECTURE  III. 


I.  PuKTHEE  Considerations  of  the  Sympathetic  System  : — 1 have  al- 
ready spoken  of  the  importance  that  we  as  Osteopaths  attach  to  centers,  espec- 
ially to  those  centers  which  I have  given  you  along  the  spine.  The  theory  of 
our  work  upon  them  and  their  significance  in  connection  with  disease  we  shall 
take  up  later.  I may  in  passing,  however,  say  that  they  are  one  of  the  most 
important  things  by  which  the  Osteopath  has  to  work.  The  same  is  true  of 
the  sympathetic  system  in  general.  The  general  anatomy  of  the  sympathetic 
system  is  doubtless  already  known  to  you,  but  there  are  points  which  I wish  to 
recall  to  your  attention  and  cite  you  their  significance  from  our  stand  point. 

Points  from  Quain  : — ^The  sj’mpathetics  are  connected  with  the  spinal 
nerves  by  white  and  gray  rami  eommunieantes.  The  white  are  medullated  and 
pass  from  the  spinal  nerves  to  the  sympathetic  ganglia.  Some  white  fibres 
pass  from  the  ganglion  to  the  efferent  ramus.  Some  end  in  the  ganglia ; they 
may  ascend  or  descend  in  the  sympathetic  cord  to  higher  or  lower  ganglia, 
thus  connecting  with  several,  and  being  in  this  manner  widely  distributed  to 
the  sympathetics.  The  gray  rami  eommunieantes  are  non-medullated,  or  pale. 
They  pass  from  the  sympathetic  ganglia  back  to  the  spinal  nerves,  the  reverse 
of  the  white  They  arise  from  cells  in  the  sympathetic  ganglia.  They  may, 
rarely  however,  run  in  the  sympathetic  cord  to  another  gauglon,  and  then 
emerge  to  take  their  co\irse  to  the  spinal  nerves.  They  enter  the  anterior  pri- 
mary division  of  the  spinal  nerves,  divide  to  send  some  fibres  centrally  toward 
the  cord,  some  peripherally  through  the  spinal  nerves  to  the  general  system. 
Those  gray  fibres  of  the  sympathetic  which  pass  centrally  join  in  part  a re- 
current branch  of  the  special  nerve  and  with  it  run  to  supply  the  vertebrae, 
the  dura  mater,  the  ligaments  and  blood  vessels  of  the  spinal  canal.  Other 
filaments  pass  over  the  bodies  of  the  vertebra  and  supply  the  intercostal  and 
lumbar  arteries  and  veins,  ligaments  and  bones.  Thus,  the  central  distribution 


8 


of  the  sympathetic  nerve  is  of  great  importance  to  the  Osteopath  in  his  work  of 
building  up  a weak  or  defective  spine,  and  helps,  in  part  at  least,  to  explain 
the  wonderful  results  he  obtains  in  that  department  of  his  work.  Those  sym- 
pathetic fibres  which  pass  distally  in  the  anterior  and  posterior  primar3’  divis- 
ions of  the  spinal  nerves  supply  the  blood  vessels  of  the  body  walls  and  mus- 
cles with  vaso-motor  fibres,  and  the  sweat  glands  of  the  skin  with  secretorj' 
fibres,  and  the  hairs  with  pilo-motor  fibres. 

Here  again  the  sympathetic  system  becomes  significant  fx’om  the  Osteo- 
pathic point  of  view,  and  aids  in  explaining  the  reason  for  the  immediate  re- 
sults attained  in  keeping  the  skin,  the  so-called  lung,  and  superficial  fascia  in 
good  working  order.  It  is  important  in  cases  of  blood  and  skin  diseases  and 
in  fevers.  The  centers  for  the  superficial  fascia,  you  will  remember  are  the 
2d  dorsal  and  the  5th  lumbar.  The  Old  Doctor,  who  in  the  past  few  months 
has  been  making  special  studies  upon  this  subject,  attaches  great  importance  to 
superficial  fascia.  Of  equal,  or  perhaps  greater  importance,  finally  are  the 
visceral  distributions  of  the  sympathetic  nerves,  there  being  efferent  oranches 
running  forward  from  the  sympathetic  ganglion  to  the  great  pre-vertebral 
plexuses,  the  cardiac,  solar,  hypogastric  and  pelvic  plexuses,  so-called  primaiy 
plexuses,  e.  g.,  the  phrenic,  renal,  spermatic,  coeliac,  superior  and  inferior 
mesenteric,  aortic,  hemorrhoidal,  vesical,  etc.  Their  importance  to  the  Oste- 
opath lies  in  the  fact  that  through  them  he  may  regulate  the  .actions  of  the  in- 
ternal viscera  to  a wonderful  degree.  Thus  we  stumble  onto  the  paradox  that 
a man’s  own  internal,  organic  life  maj'  come  under  the  control  of  another  to  a 
greater  or  less  extent. 

Some  gray  fibres  pass  from  the  ganglia  out  over  the  efferent  rami.  I have 
placed  here  upon  the  board  a diagram  from  Quain  in  which  you  note  illustrat- 
ed the  points  which  I have  brought  out  concerning  the  gray  and  white  rami 
communicantes  and  their  connections  with  the  anterior  and  posterior  divisions 
of  the  spinal  nerves,  their  course  toward  the  cord  and  also  the  efferent  rami 
running  outward  to  the  great  pre vertebral  plexuses.  The  medullated  fibres, 
that  is,  those  of  the  white  rami,  may  be,  1st,  sensor^q  running  from  the  poster- 
ior root  of  the  spinal  nerve  ; 2nd,  vaso  and  viscero-constrictors,  from  the  9th, 
lOth  and  11th  cranial  nerves  ending  in  the  sympathetic  ganglion,  whence  their 
action  is  carried  out  through  pale  fibres  rising  from  cells  in  the  ganglia.  These 
fibres  thus  have  become  demedullated  by  passing  through  the  sympathetic  gan- 
glia, 3rd  vaso  dilators  from  the  anterior  and  posterior  spinal  roots,  and  from 
the  9th,  10th  and  11th  cranial  nerves,  pass  through  the  sympathetic  ganglia, 
do  not  connect  with  any  nerve  cells  therein,  and  reach  the  organ  they  supply 
as  medullated  nerves. 

II.  Landmarks.  A tabular  plan  of  the  parts  opposite  the  spines  of  the 
vertebrae.  After  Holden.  Opposite  7th  cervical  spine,  apex  of  lung,  higher 
in  females. 


9 


Opposite  3rd  dorsal,  aorta  reaches  spine,  apex  of  lower  lobe  of  lung,  angle 
of  bifurcation  of  trachea. 

Opposite  4th  dorsal  spine,  aortic  arch  ends;  upper  level  of  heart. 

“ “ 8th  “ “ lower  level  of  heart ; central  tendon  of  diaphragm 

“ 9th  “ “ msophagus  and  vena  cava  perforate  diaphragm; 

upper  edge  of  spleen. 

Opposite  loth  dorsal  spine,  lower  edge  of  lung;  liver  comes  to  the  surface 
posteriorly;  cardiac  orifice  of  stomach. 

Opposite  11th  dorsal  spine,  lowest  part  of  pleura;  aorta  perforates  dia- 
phragm ; pylorus. 

Opposite  1st  lumbar  spine,  renal  artery;  pelvis  of  kidney. 

“ 2nd  “ “ termination  of  spinal  cord;  pancreas;  duode- 

num just  below;  receptaculum  chyli. 

Opposite  3rd  lumbar  spine,  umbilicus : lower  border  of  kidney. 

“ 4th  “ “ division  of  aorta ; highest  2>art  of  ilium. 

Apex  of  lung  is  most  liable  to  disease ; may  be  examined  by  percussion  at 
external  end  of  clavicle. 

Angle  of  junction  of  trachea  is  in  some  cases  opposite  the  4th  dorsal  spine. 
This  angle  corresponds  in  front  with  the  junction  of  the  first  and  second  parts 
of  the  sternum.  As  to  the  kidney,  its  upper  border  may  be  as  high  as  the  level 
of  the  space  between  the  11th  and  12th  dorsal  spines.  Its  lowei  border  may 
extend  as  low  as  the  3rd  lumbar  spine. 

III.  How  TO  Examine  a Spine.  (Continued.)  I spoke  in  a previous  lec- 
ture of  variations  of  curves  of  the  spine  from  the  normal.  A few  more  words 
concerning  this.  There  may  come  to  your  notice  in  your  examination  of  a 
spine  a flattening  between  the  shoulders ; on  the  contrary,  the  tendency  there 
may  be  posteiior  decidedly.  The  same  condition  may  prevail  immediately  be- 
low the  shoulders  about  the  middle  of  the  back.  You  may  have  a posterior 
flattening  of  the  lumbar  region,  which  naturally,  as  5^11  know,  is  curved  an- 
teriorly. But,  on  the  other  hand,  you  may  have  too  pronounced  a tendency 
anteriorly  in  this  region.  Again,  you  may  have  all  of  the  normal  curves  of  the 
spine  lessened,  leaving  what  we  describe  as  a straight  spine.  You  will  readily 
see  that  in  such  a condition  the  whole  equilibrium  of  the  body  is  more  or  less 
disturbed.  Y"ou  may  find  the  sacrum  itself  too  prominent  posteriorly,  or  too 
flat,  thus  increasing  or  diminishing  the  antero-posterior  diameter  of  the  pelvis. 
Finall}",  you  may  find  that  the  coccyx  has  been  bent  to  one  side,  in  which  case 
it  may  be  the  cause  of  piles ; it  may  be  bent  forward,  as  frequently  you  will 
find,  from  horseback  riding,  etc.  In  such  a case  it  may  become  a mechanical 
impediment  to  the  passage  of  fecal  matter,  thus  mechanically  causing  consti- 
pation. Remember,  please,  that  in  calling  your  attention  to  these  points  in 
how  to  examine  a spiue,  I have  left  aside  the  subject  of  their  significance. 
That  subject  will  be  fully  considered  in  later  lectures. 


10 


LECTURE  IV. 


.1.  HOW  TO  EXAjMINE  A SPINE  (CONCLUDED.) 

There  are  a few  more  points  regarding:  the  abnormal  curves  of  the  spine, 
which  r think  will  be  useful  to  you — flattening  between  the  shoulders  or  pos- 
terior tendency  there — the  posterior  tendency  that  we  frequently  meet  with 
along  the  lumbar  region  or  flattening  there.  Then  the  different  positions  that  we 
find  upon  examination  that  the  coccyx  has  assumed,  and  the  different  positions 
in  which  we  find  the  sacrum  itself.  Also  I may  mention  the  fact  that  there 
may  be  considerable  variation  in  the  curves  of  the  spine,  so  that  you  may  have 
quite  a straight  spine  by  the  time  you  have  looked  over  all  the  points.  Hence, 
the  natural  equilibrium  may  be  destroyed  in  that  way. 

There  is  one  other  point  which  you  will  probably  find,  and  that  is  that  a 
vertabra  may  not  only  be  slipped  from  side  to  side,  but  by  following  the  curve 
along  the  spine  we  may  at  any  point  come  to  a vertebra  extending  backward — 
not  only  one  or  two,  but  several  may  be  displaced  backward  ; or  you  may  find 
a single  one  displaced  anteriorly.  I was  treating  a case  not  long  ago  in  which 
one  of  the  dorsal  vertebrae  was  pushed  anteriorly,  and  it  had  an  effect  upon  the 
kidneys.  It  generally  affects  the  center  near  where  it  occurs. 

Hilton  says  that  frequently  he  has  found  that  a pressure  of  the  head 
straight  downward  on  the  spine,  and  then  rotation  from  side  to  side  will  cause 
a sensation  of  pain  in  the  cervical  region,  and  will  be  evidence  of  disease  there, 
when  one  has  not  been  able  to  find  it  by  any  other  diagnosis.  He  has  found 
that  the  general  symptoms  justified  his  locating  the  disease  in  the  upper  cer- 
ical  vertebra. 

There  is  another  point  that  is  not  of  very  much  importance  to  you,  but 
you  should  understand  it,  because  your  patients  will  notice  it  probabl,y  and  are 
apt  to  ask  you  to  explain  why  it  should  occur.  That  is,  as  you  work  along  the 
spine  you  may  hear  certain  noises,  somewhat  like  popping.  You  will  find  them 
all  along  the  spine,'  sometimes  distinctlj"  on  one  side,  sometimes  distinctly  on 
the  other.  Also  when  you  are  working  in  the  neck,  moving  it  from  side  to 
side  or  in  any  way,  jmu  may  get  a click.  Or  the  patient  may  hear  it  when  he 
is  turning  his  head  from  side  to  side.  Now  the  reason  as  to  why  you  hear 
these  noises  along  the  spine  is  explained  differently  in  the  different  regions. 
In  the  dorsal  region  there  are  three  things  that  may  move.  The  whole  verte- 
bra may  be  moved ; of  course  there  is  inter-vertebral  motion,  but  we  do  not  get 
many  of  these  noises  from  that  cause,  on  account  of  the  way  the are  bound 
together,  being  connected  by  inter-vertebral  discs,  with  no  synovial  mem- 
brane. The  second  place  in  which  you  may  get  motion  is  between  the  head  of 
the  rib  and  its  articulation  with  the  bodies  of  the  vertebrte  and  the  inter-verte- 
bral substances.  Then,  in  the  third  place,  you  may  have  motion  between  the 
tubercles  where  they  articulate  with  the  transverse  processes  of  the  next  verte- 


11 


bra  below.  In  the  neck  the  only  place  you  are  liable  to  get  any  click  is  be 
tween  the  articular  processes  of  the  vertabrse.  These  noises  in  the  spine  are  not 
of  much  significance,  but  you  will  meet  them  and  of  course  would  like  to  un- 
derstand them  for  the  patient’s  sake,  because  if  they  find  you  do  not  under- 
stand these  things,  you  may  lose  a valuable  patient. 

n.  OSTEOPATHIC  SIGNIFICANCE  OP  POINTS  OBSERVED  IN  EXAI\riNATION 

OF  THE  SPINE. 

After  understanding  fully  how  to  examine  the  spine,  your  next  question 
naturally  is,  when  I have  found  these  things  along  the  spine,  what  is  their  sig- 
nificance? If  we  do  not  know  what  they  mean  they  are  useless  to  us.  "When 
once  you  know  the  results  of  certain  lesions  it  does  not  take  you  long  to  find 
the  lesion.  I have  therefore  for  the  present  dropped  the  subject  of  the  sympa- 
thetic nerve,  and  have  decided  to  devote  one  or  two  lectures  to  the  general 
consideration  of  the  osteopathic  significance  of  the  points  which  we  find  in  our 
examination  of  the  spine.  Reinember,  [ilease,  that  this  cannot  be  given  to  you 
in  full  by  lectures,  and  that  you  will  only  recognize  the  full  significance  in 
your  practice.  I can  make  it  plainer  later  when  we  take  u])  particular  cases. 
What  I want  to  do  is  to  show  you  the  significance  of  certain  points,  and  to  get 
you  into  the  habit  of  osteopathic  reasoning — to  show  you  how  we  look  at  these 
things,  and  the  process  of  thought  followed. 

The  first  point,  then,  is  as  follows:  In  general,  a lesion  along  the  spine, 

whatever  its  character,  affects  the  center  at  which  it  occurs,  and  thus  may  affect 
cerebro-spinal  life  or  sympathetic  life,  either  or  both.  The  former  if  it  is  more 
superficial,  in  general,  and  the  latter  if  is  deeper  in  general.  As  to  the  charac- 
ter of  the  lesion,  it  may  be  of  any  form  found  in  the  examination  of  the  spine. 
As  to  locality,  it  may  be  either  superficial  or  deep  You  ma}'  find  along  be- 
tween the  shoulders  a flattening,  which  may  extend  as  low  as  the  8ih  dorsal, 
and  interfere  with  the  centers  for  the  stomach.  If  it  be  serious  in  character  it 
will  extend  deep  enough  to  affect  the  sympathetics,  and  thus  organic  life,  and 
you  will  probably  have  stomach  trouble.  If  it  is  not  deep  enough  to  affect 
the  sympathetic  life,  it  may  affect  the  cerebro-spinal  life  and  you  will  have  a 
lame  back  ; or  if  it  is  in  the  region  of  the  (ith  or  7th  dorsal,  pains  may  run 
around  the  ribs  and  meet  over  the  pit  of  the  stomach  at  tne  abdomen.  The 
character  of  the  injury  may  be  such  that  it  affects  deeper  structures,  or  it  may 
have  a more  superficial  effect. 

The  next  point  in  osteopathic  reasoning  is  the  consideration  of  the  amount 
or  intensity  of  life  displayed  in  any  given  condition.  This  is  an  important 
point,  and  perhaps  not  clearly  expressed,  but  I will  try  to  make  it  plain  to  you. 
Yon  may  have  a rigid  spine,  or  you  may  have  a relaxed  spine.  Now,  in  gen- 
eral, the  process  of  reasoning  which  the  osteopath  uses  is  about  as  follows: 
The  fact  that  the  spine  is  relaxed  shows  a lack  of  nerve  force,  a lack  of  life 


12 


there.  On  the  other  hand,  it  there  is  ^reat  tension  along  the  spine,  the  spine 
is  closely  hound  down  and  held  together  by  the  ligaments,  so  that  you  have  a 
rigid  spine  with  little  motion,  the  reasoning  wonld  be,  to  some  extent  at  least, 
that  there  had  been  an  injury  to  the  spine  or  a strain  that  had  resulted  in  di- 
recting too  much  nei’ve  force  to  that  part  of  the  body  for  a shorter  or  longer 
period  of  time,  which  resulted  in  throwing  too  much  food  supply  there,  caus- 
ing a thickening  of  the  ligaments  binding  the  vertebra  together.  Of  course 
collaterally,  when  too  much  life  and  vigor  was  thrown  to  that  part  it  was  rob- 
bing some  other  point. 

Take  several  illustrations  to  make  this  clear : You  may  have  a tension  in 

the  spinal  muscles  behind.  It  may  seem  queer  to  you,  or  to  your  patients, 
for  you  to  tell  them  that  a muscle  is  contracted,  congested  or  drawn,  and  has 
remained  that  way.  It  is  hard  to  believe  but  such  is  the  fact.  What  does 
such  a condition  argue  to  your  mind?  Simply  that  there  is  too  great  an 
amount  of  nerve  force  there,  which,  reacting  upon  the  muscles,  causes  them  to 
contract.  In  that  case  your  nervous  force  is  in  the  nature  of  a violent  stimu- 
lation to  those  terminal  sensory  nerves.  On  the  other  hand,  it  mav  be  second- 
ary from  the  condition  of  an  internal  viseus.  There  may  be  some  visceral  dis- 
ease, say  stomach  trouble,  which  would  be  reflected  from  the  solar  plexus  out 
along  the  splanchuics  to  those  spinal  nerves,  and  through  those  spinal  nerves 
back  to  their  distribution.  There  may  be  a misdirection  of  the  nerve  force  or 
life,  which  life  is  sent  to  the  spinal  muscles,  and  you  have  too  great  a supply 
of  nerve  force  along  the  spine.  We  reason  according  to  the  amount  of  nerve 
force  or  life  sent  to  these  points  Again,  when  you  make  a dighal  examina- 
nation  of  the  rectum,  yon  may  find  that  there  is  some  irritation  which  acts  in 
the  nature  of  a stimulation  to  the  nerve  force  which  supplies  that  rectal  sphinc- 
ter, and  IS  causing  it  to  contract.  On  the  other  hand,  you  will  find  in  some 
examinations  that  there  is  no  force  put  forth  whatever,  the  sphincter  is  relaxed, 
and  in  such  cases  it  is  very  likely  that  the  patient  is  suffering  from  inconti- 
nence of  the  fecal  matter.  In  the  one  case  there  is  too  much  nerve  life,  in  the 
other  too  little.  This  may  also  result  from  visceral  troubles.  In  a case  of 
diarrhoea  the  osteopath  first  examines  to  find  some  lesion  along  the  spine  at 
the  Dth,  10th,  or  11th  dorsal,  causing  too  much  nerve  force  to  be  directed  from 
the  sympathetic  system  to  the  intestine  so  that  there  is  too  rapid  peristalsis  and 
also  too  great  a secretion  of  watery  matter.  There  is  too  much  nerve  life 
there,  or  there  could  not  be  too  much  motion.  On  the  other  hand,  in  consti- 
pation, either  something  has  happened  to  deaden  the  nerve  force  or  to  dissem- 
inate nerve  force  to  other  parts  of  the  body  so  that  vou  have  too  little  left. 
You  have  not  enough  energy  to  pass  the  fecal  matter  along  its  course,  and  the 
result  is  a case  of  constipation.  This  is  not  a full  explanation  of  all  these 
cases,  but  I simply  use  them  as  illustrations.  You  will  find  this  a valuable 
)ioint  in  osteopathic  reasoning.  In  the  former  case  the  osteopath  adopts  such 


13 


measures  as  will  disseminate  the  uei’ve  force  and  equalize  it  throughout  the 
body.  In  the  latter  ease  he  directs  his  attention  to  a rational  means  of  renew- 
ing the  nerve  force  which  is  lacking  at  the  given  point  affected. 

When  you  find  upon  examination  that  the  spines  are  separated,  what 
is  your  conclusion  ? Simply  that  some  lesion  has  caused  a relaxation.  There 
is  too  little  life,  and  hence  a separation.  This  may  impinge  upon  the  nerve 
centers  and  there  will  be  trouble  according  to  the  center  over  which  the  lesion 
has  occurred.  In  a case  of  a “smooth  spine’’,  where  every  vertebra  seems  to 
be  jammed  down  close  to  its  fellow,  there  seems  to  have  resulted  a contraction 
of  the  ligaments  connecting  them,  affecting  almost  all  of  the  centers  along  the 
spine  to  a greater  or  less  degree ; there  maj^  result  neurasthenia,  a general  lack 
of  nutrition,  general  eye  troubles,  nervous  troubles,  circulatory  affections. 

A spine  twisted  leads  us  to  look  at  the  center  which  is  affected.  This 
brings  us  to  the  tension  on  the  ligaments  which  I have  mentioned  a time  or  two 
before.  When  we  have  a case  in  which  there  is  a twist  of  the  vertebra,  we  rea- 
son from  the  position  of  parts  as  to  what  ligaments  are  affected.  Suppose,  for 
instance,  that  a vertebra  is  twisted  so  that  a spine  instead  of  being  exactly  in 
line,  is  turned  toward  the  right,  then  what  is  the  condition  of  the  ligaments? 
The  anterior  and  posterior  ligaments  along  the  bodies  of  the  vertebra  will  be 
obliquely  upon  a tension,  the  supra-spinous  and  inter-spinous  ligaments  will  al- 
so be  upon  a strain,  the  ligamentum  subflavum  on  the  left  side  will  be  tightened 
and  that  on  the  right  side  tightened  also ; the  inter-transverse  ligaments  on 
each  side  will  be  tight,  and  extend  one  forward  and  the  other  backward.  This 
is  the  method  of  reasoning  you  should  adopt,  and  you  should  reason  from  the 
symptoms  as  to  what  nerves  are  affected.  You  will  find  that  the  ligaments 
may  draw  across  nerves  in  such  a way  as  to  affect  nervous  life,  either  spinal 
alone  or  sympathetic  through  the  spinal. 

I mentioned  along  the  spine  certain  peculiar  vertebne.  In  regard  to  the 
second  cervical  vertebra,  if  3'ou  are  a young  Osteopath  and  examining  your 
first  patient,  you  will  be  sure  to  find  something  wrong  with  that  vertebra. 
Please  bear  in  mind  that  it  is  not  like  the  others,  but  has  a prominent  forked 
spine.  You  may  make  the  same  mistake  with  the  7th  cervical.  You  should 
acquaint  yourselves  with  these  natural  conditions,  so  that  you  can  judge  cor- 
rectly as  to  any  change  from  the  normal  condition.  Then  bear  in  mind  also 
that  the  12th  dorsal  and  the  oth  lumbar  are  very  apt  to  be  points  of  mischief, 
and  a separation  is  very  likely  to  take  place  at  those  points.  Between  the  .5th 
lumbar  and  the  sacrum  is  a point  which  is  frequently  affected  and  which  makes 
a great  deal  of  trouble.  The  5th  lumbar  may  be  anterior  or  it  may  be  posterior, 
and  in  such  a case  it  depends  upon  your  other  s.ymptoms  as  to  how  you  will  di- 
agnose your  case.  This  may  cause  trouble  with  the  viscera  supplied  by  the 
sympathetic  nerve,  there  may  be  uterine  trouble,  trouble  with  the  generative 
organs  of  either  sex,  paresis,  paralysis,  or  sciatica. 


14 


Iq  these  variations  from  the  normal  curves  of  the  spine  in  general  the  sig- 
nihcation  to  the  Osteopath  is  as  follows  : If  there  is  a flattening  or  posterior 
tendency  between  the  shoulders,  you  will  generally  fluid  that  the  patient  has 
heart  or  lung  trouble.  You  will  expect  to  find  some  lesion  there  affecting  those 
organs,  which  acts  directly  by  impinging  upon  the  nerves  or  by  changing  the 
position  of  the  ribs.  There  may  be  a change  in  the  first  or  second  rib,  causing 
heart  trouble  ; of  the  7th  rib,  causing  asthma.  You  may  have  heart  or  lung 
trouble  there,  or  if  it  is  as  low  as  the  8th  dorsal  you  may  have  stomach  trouble, 
or  there  may  be  renal  trouble  caused  by  a lesion  as  high  as  the  2nd  dorsal,  or 
sciatica  as  high  as  the  2nd  dorsal.  You  must  reason  according  to  the  centers 
affected.  If  there  is  a change  from  the  natural  curve  in  the  region  of  the 
splachnics  from  below  the  shoulders  to  the  first  lumbar,  then  look  for  such 
troubles  as  intestinal  affections,  renal  troubles.  This  same  reasoning  applies 
in  general  to  the  sacrum  and  coccyx.  The  coccyx  may  cause  either  mechanic- 
al troubles,  such  as  piles  and  constipation,  or  sympathetic  trouble  and  affect 
the  internal  viscera  in  that  way. 

The  osteopath  finds  the  atlas  of  great  importance  to  him  in  his  work  for  the 
reason  that  it  may  impinge  upon  certain  nerves,  and  may  affect  spinal  centers, 
or  it  may  act  in  such  a way  as  to  deprive  the  brain  of  its  supply  of  nutrition, 
and  thus  lead  to  results  which  are  very  significant  to  the  osteopath.  It  may  act 
in  such  a way  as  to  shut  off  the  blood  supply  to  the  brain  and  it  may  affect 
every  center  in  the  brain.  Hence,  you  may  commonly  find  that  your  patient 
has  been  unable  to  speak  for  a long  time,  or  has  been  unable  to  hear  plainly,  ©r 
he  may  have  become  insane.  It  may  also  impinge  so  much  that  it  presses  on 
the  cord  and  robs  it  of  its  nutrition,  so  that  there  may  follow  various  spinal 
troubles.  It  may  press  upon  it  on  one  side,  causing  hemiphlegia,  the  patient 
having  no  use  of  one  half  of  his  body,  the  legs  and  the  arms  being  small  in  the 
case  of  a child,  where  the  development  has  been  impaired.  This  is  the  Osteo- 
pathic way  of  looking  at  a case  when  you  find  that  the  first  cervical  has  been 
slipped.  I had  a case  of  this  kind  not  long  ago.  The  result  was  that  the  child 
could  not  speak;  it  could  say  ‘-Mamma”  but  everything  else  that  it  said  was 
just  a peculiar  sound,  it  could  not  articulate  except  that  single  word.  In  addi- 
tion to  that,  its  left  side  was  paralyzed,  or  there  was  a paresis  there,  the  child 
limped,  the  leg  was  short  and  the  arm  was  drawn  up.  The  whole  trouble  there 
was  really  at  the  first  cervical  vertebra,  which  was  slipped,  affecting  the  spinal 
cord  and  the  brain,  either  through  its  blood  supply  or  directly  by  impingement. 

What  IS  the  significance  of  the  noises  that  we  find  along  the  spine?  Usu- 
ally nothing  whatever.  You  may  find  noises  all  along  the  spine  in  a man  who 
is  cj[uite  healthy.  But,  on  the  other  hand,  it  may  have  considerable  significance 
and  these  the  Osteopath  should  always  take  into  consideration.  As  I have  ex- 
plained, either  the  heads  or  tubercles  of  the  ribs  may  be  slipped,  or  the  position 
of  the  vertebra  may  be  changed,  or  the  articular  processes  may  cause  a great 


15 


deal  of  trouble  in  the  neck.  The  Osteopath  in  thinking  of  these  things  thinks 
of  the  normal  anatoinj^  of  the  part.  He  says,  here  is  a point  which  may  be  sub- 
jected to  a strain  or  twist,  it  can  be  extended  or  shortened  to  some  extent,  so 
that  these  are  movable  points ; and  being  points  at  which  a strain  may  occur, 
are  points  which  are  liable  to  disease.  You  will  find  this  of  great  significance 
in  the  etiology  of  spinal  curvature.  Along  this  line  I simply  want  to  quote 
from  Halliburton.  He  says  “Disease  of  the  spine  may  begin  in  the  vertebree  or 
in  the  inter- vertebral  substances;  I think  on  the  whole,  in  the  intervertebral 
substances  where  it  is  joined  to  the  vertebrae.”  His  editor,  Dr.  Jacobson,  says 
that  his  view  is  supported  by  the  fact  that  the  junction  of  a more  with  a less 
elastic  body  is  the  weakest  spot  and  therefore  receives  the  full  effect  of  the 
strain.  He  instances  the  case  of  an  atheromatous  artery,  the  weakest  portion 
is  where  the  diseased  wall  joins  with  the  more  elastic  substance  of  the  healthy 
wall,  and  it  is  at  that  point  where  the  real  strain  comes  and  where  an  aneurism 
is  likely  to  occur.  Hence,  as  I explained,  here  arises  for  the  Osteopath  the 
significance  of  a distorted  vertebra,  causing  a slight  irritation  of  the  parts 
throwing  to  much  blood  and  nerve  force  and  life  there  and  setting  up  some  ir- 
ritation, causing  a thickening  of  the  ligaments  and  perhaps  a permanent  inju- 
ry to  certain  parts,  especially  the  nerves. 

The  Osteopath  realizes  that  the  ill  effects  of  injuries  along  the  spine  are 
not  dependent  upon  their  great  extent.  That  is  to  say,  you  may  have  a very 
bad  curvature  of  the  spine  which  is  congenital  or  there  may  be  a very  bad  cur- 
vature of  the  spine  which  had  come  on  through  years,  without  very  serious 
trouble  following.  In  such  cases  where  the  curvature  has  covered  a very  long 
period  of  time,  or  where  a child  has  been  born  so,  the  parts  become  adapted  to 
the  variation  from  the  normal,  and  such  persons  may  go  through  life  with 
good  organic  life.  I have  seen  some  cases  of  dw’arfs  or  hunch  backs  who  had 
very  good  health ; and,  reasoning  from  the  Osteopathic  standpoint,  we  some- 
times wonder  why  it  is  in  such  pronounced  curvatures  of  the  spine,  the  person 
does  not  have  stomach  trouble,  bowel  trouble,  whv  the  kidneys  are  not  affect- 
ed, and  so  on.  On  the  other  hand,  you  may  have  a man  with  a sound  back, 
but  who  has  a little  twist  of  one  vertebra,  which  may  make  him  a great  deal  of 
trouble.  So  the  osteopath  reasons  not  from  the  great  extent  of  the  departure 
from  normal,  but  from  the  center  affected  and  from  antecedent  conditions.  Hil- 
ton says  that  almost  all  diseases  of  the  spine  are  the  result  of  some  slight  strain 
or  some  slight  accident,  and  that  is  what  the  Osteopath  finds  every  week  of  his 
practice.  A man  will  come  into  your  office  in  trouble ; you  will  find  a spinal 
lesion.  He  knows  he  never  fell,  a horse  never  kicked  him  or  anything  of  that 
kind,  but  in  about  three  weeks  he  will  come  back  and  tell  you  that  he  went 
home  and  talked  it  over  with  his  wife,  and  she  reminded  him  of  that  time  he 
fell  down  the  court  house  steps,  or  something  of  that  kind.  He  has  had  some 
accident  which  he  has  overlooked,  but  which  has  caused  some  slight  lesion  of 


16 


the  spine,  taking  time  to  develop,  but  which  has  at  last  caused  considerable 
trouble.  Hilton  also  instances  a very  serious  case  in  which  the  lesion  of  the 
spine  was  not  discovered  at  all ; it  was  only  after  the  patient  had  been  fourteen 
years  a paralytic  and  died  that  post  mortem  revealed  the  fact  that  the  5th,  6th 
and  7th  cervical  vertebrae  had  been  ankylosed.  The  fall  which  caused  it  was 
a fall  of  forty  feet  upon  his  back  and  neck ; upon  examination  of  the  patient 
he  was  unable  to  find  any  lesion  in  these  parts  at  the  time.  So  the  lesion  may 
not  be  discoverable. 

Once  more,  Hilton  says  that  he  believes  many  cases  of  spinal  diseases  are 
due  to  to  a slight  injury  which  has  been  overlooked  or  to  exercise  persisted  in 
after  fatigue.  A man  falls  down,  says  he  has  not  been' hurt,  gets  up  and  rubs 
himself  to  restore  circulation,  and  thinks  nothing  more  of  it;  but,  as  Hilton 
says,  very  slight  injuries  may  cause  very  serious  results,  and  the  osteopath  has 
to  take  all  these  things  into  consideration,  and  reason  accordingly. 


LECTURE  V. 


At  the  last  lecture  I called  your  attention  to  how  to  examine  the  spine, 
concluding  that  subject.  I also  took  up  the  osteopathic  significance  of  certain 
special  points  which  we  had  before  noticed  in  our  examination  of  the  spine. 
In  general,  a lesion  affects  a center  over  which  it  occurs.  The  osteopath  rea- 
sons from  the  amount  of  iuteusitj^  of  nerve  force  displayed  at  any  point.  Spines 
may  be  separated  or  approximated.  I called  attention  to  the  special  vertebra, 
the  2nd  and  7th  cervical,  and  lesions  at  the  12th  dorsal  and  5th  lumbar,  and 
instanced  the  results  of  such  lesions.  I called  your  attention  to  the  displace- 
ment of  the  atlas,  stating  that  it  was  of  great  significance  to  the  osteopath,  as 
it  may  shut  off  blood  supply  to  the  brain  and  may  impinge  upon  the  cord,  caus- 
ing serious  troubles.  I also  called  your  attention,  finally,  to  the  fact  that  the 
osteopath  does  not  measure  the  injury  by  its  vast  extent,  instancing  the  case  of 
a hunch  back  with  good  organic  health,  versus  the  case  of  a man  wdth  a slight 
slip  or  twist  of  one  vertebra  having  great  trouble. 

I wish  to-day  to  continue  this  line  of  thought,  taking  up,  then,  as  the  head 
of  this  lecture ; The  further  consideration  of  the  osteopathic  significance  of 
points  in  diagnosis.  I failed  to  explain  fully  to  jmu  the  significane  of  the 
clicking  in  the  neck.  From  what  I said  you  may  have  gathered  the  impression 
that  it  has  no  significance,  or  very  slight,  as  those  noises  which  occur  lower  in 
the  spine.  Such  is  not  the  case,  however,  if  you  hear  a near  click,  the  reason 
is  that  something  has  shut  off  the  blood  supply,  it  may  have  been  a little  strain, 
a congestion  of  the  muscles,  anything  that  will  produce  a tension  over  the 
blood  vessels,  or  affect  their  vaso-motor  fibres,  causing  a constriction  and  shut- 
ting off  the  blood.  This  may  prevent  the  right  amount  of  lubrication  being 


deposited  in  the  synovial  membrane  between  the  articular  processes  of  the  ver- 
tebra, hence,  yon  have  the  vertebra  too  close  together,  and  the  patient  in  turn- 
ing his  head,  or  upon  its  being  turned  by  the  operator,  elicits  a click  or  grat- 
ing, and  the  patient  wonders  what  that  is.  To  you  such  noises  are  of  consid- 
erable significance. 

You  may  find  it  useful  to  consider  the  various  troubles  which  you  will 
find  in  your  prrctice  in  relation  to  the  plexuses  from  which  they  arise,  and  if 
you  adapt  yourself  to  this  habit  of  thought,  and  at  once  think,  when  you  see 
trouble  in  oue  part  of  the  body,  where  that  may  have  come  from,  what  plexus 
is  affected,  and  what  region  in  the  spine,  I think  it  will  be  of  considerable  use 
to  you.  Now,  there  may  be  lesions  of  certain  groups  of  nerves, — the  upper 
cervical  group  of  nerves,  those  from  the  first  to  the  fourth  inclusive,  may  be 
affected  by  spasms,  by  convulsions,  or  by  paralysis  in  general.  I wish  to  call 
your  attention  to  some  points  in  relation  to  the  distribution  of  nerves,  and 
show  you  how  important  it  will  be  to  you  as  osteopaths  to  have  a good  knowl- 
edge, a knowledge  which  you  can  quickly  call  into  use,  of  the  distribu- 
tion of  the  various  nerves  in  the  body.  You  may  have  a pain  in  the  ear 
— the  person  whom  it  affects  may  describe  it  as  an  ear-ache.  If  this  ear- 
ache occurs  upon  the  anterior  pendulous  portion  of  the  ear,  or  upon  the  poste- 
rior aspect  of  the  ear,  you  will  have  to  refer  that  pain  to  the  2nd  cervical  nerve, 
which  supplies  those  parts.  If  the  ear-ache  is  in  the  canal  of  the  ear,  or  the 
upper  anterior  portion  of  the  ear,  you  will  have  to  refer  that  trouble  to  the  5th 
cranial  nerve.  Hilton  states  how  it  was  that  he  happened  to  find  so  definite^ 
just  how  these  nerves  were  distributed  to  the  ear.  The  case  was  that  in  which 
an  attempt  had  been  made  to  cut  a person’s  throat;  the  auricular  branch  of  the 
second  cervical  nerve  had  been  divided  so  that  sensibility  had  entirely  departed 
from  the  posterior  and  lower  parts  of  the  ear.  By  pricking  very  carefully  over 
the  whole  surface  of  the  ear  he  found  just  the  distribution  of  the  nerves.  You 
may  have  the  ear-ache  and  the  tooth-ache.  And  why?  Simply  because  the 
5th  nerve  supplying  the  auditory  canal  supplies  also  by  the  superior  and  in- 
ferior maxillary  branches,  the  teeth  of  the  upper  and  lower  jaws  respectively. 
You  may  have  ear-ache  associated  with  disease  of  the  anterior  third  of  the 
tongue,  simply  because  the  5th  nerve,  which  supplies  sensations  to  the  anterior 
third  of  the  tongue  also  supplies  the  auditory  canal.  Pain  in  the  anterior 
lateral  part  of  the  scalp,  over  the  temples,  pain  in  the  face  ejms,  nose,  tongue 
and  teeth  you  refer  to  this  same  5th  cranial  nerve.  On  the  other  hand  in 
case  the  pain  is  in  the  back  of  the  scalp,  we  have  two  areas,  one  supplied  by  the 
great  occipital  nerve,  and  oue  by  the  small  occipital,  brauches  of  the  2nd  cer- 
vical nerve.  So  it  is  that  you  have  these  areas  of  distrubutiou  given  so  that 
you  can  reason  and  thus  refer  pains  in  a particular  part  back  to  the  origiu  of 
the  nerves.  Both  the  5th  nerve  and  these  upper  cervical  nerves  are  readily 
accessible  to  the  operator.  You  thus  see  what  the  signilicauce  of  these  things 


18 


are  to  the  osteopath  in  enabling  him  to  make  a correct  diagnosis.  If  he  is 
not  acquainted  with  the  distribution  of  these  nerves  he  is  not  able  to  trace  back 
and  find  the  seat  of  the  lesion.  So  it  is  by  following  correctly  the  distribution 
of  the  nerves  you  may  tit  yourself  to  make  a correct  diagnosis. 

In  general  the  diseases  which  occur  from  lesions  in  this  upper  cervical  re- 
gion are  such  troubles  as  toixicollis,  troubles  with  the  phrenic  nerve — hiccough, 
neuralgia,  and  troubles  of  that  kind.  Of  course  the  osteopath  finds  trouble 
with  the  phrenic  nerve  lower  than  the  upper  cervical  group,  generally  arising 
from  the  3rd,  4th  and  5th  ceiwical.  When  an  osteopath  meets  such  disease  as 
crutch  paralysis,  writer’s,  violinist’s  or  pianist’s  cramp  he  refers  such  cases  to 
the  plexus  at  some  point,  or  to  a lesion  affecting  it  centrally.  I remember  a 
ease  of  crutch  paralysis  which  I treated.  It  was  simply  secondary  from  the 
use  of  a crutch,  the  crutch  pressing  upon  the  median  nerve  which  comes  from 
the  inner  and  outer  cords,  thus  affctiug  that  nerve  and  consequently  the  thumb 
and  first  finger,  which  are  supplied  by  it.  Learn,  then,  to  reason  as  to  which 
plexus  is  affected.  Having  known  this  and  how  to  treat  it,  your  diagnosis 
will  be  correct,  and  you  will  be  able  to  go  understandingly  about  what  you  are 
trying  to  reach. 

Hilton  considers  diseases  of  the  upper  cervical  vertebaae  among  the  most 
serious  which  may  affect  the  spine.  I quote  fromhim  as  follows:  “No  cases  of 
disease  of  the  spine  are  so  immediately  dangerous  to  life  as  those  of  the  upper 
part  of  the  cervical  region,  especially  if  situated  between  the  first  and  second 
cervical  vertebrae.”  The  reason  of  this  is  the  close  proximity  of  the  bones  to 
the  spinal  cord.  There  is  danger  of  rupture  of  the  ligaments  about  the  odon- 
toid process  of  the  axis,  and  in  case  this  is  ruptured  or  worn  away  by  disease, 
the  medulla  may  be  impinged  upon,  thus  affecting  the  centers  located  there,  es- 
pecially the  center  of  respiration,  and  so  cause  death.  He  instances  a case 
which  I have  thought  would  be  useful  to  you.  He  had  a case  of  a lady  who 
was  affected  thus  : She  had  pains  upon  the  left  side  of  her  head  at  the  back, 

pains  behind  the  ear,  and  over  the  clavicle  and  shoulder,  pain  and  muscu- 
lar paralysis  of  the  left  arm  and  deeper  pain  in  the  neck,  which  became  appar- 
ent by  pressure  of  the  head  straight  down  upon  the  spine  and  rotation  of  the 
parts  there.  He  found  that  about  the  1st,  2nd  and  3rd  cervical  vertebrie  there 
was  some  tenderness  slightly  more  marked  on  the  left  than  on  the  right.  He 
anticipated,  that  there  was  a history  of  some  accident,  but. could  find  none,  as 
the  lady  knew  of  no  accident  that  had  occurred.  Her  general  health  was  very 
much  affected ; she  was  unable  to  work ; for  she  had  very  sleepless  nights,  and 
her  nervous  system  was  yery  much  affected  in  general.  He  diagnosed  this 
case,  of  course,  from  the  tenderness  in  the  cervical  region  ; he  diagnosed  it  as 
a disease  affecting  the  second  cervical  nerve,  hence  the  pain  is  in  the  back  of 
the  head;  he  diagnosed  it  as  affecting  the  3rd,  hence  its  distribution,  also  as 
affecting  those  parts  supplied  by  the  nerves  which  go  to  make  up  the  brai  hial 
plexus. 


19 


I simply  bring'  this  out  to  demonstrate  the  need  of  accuracy  in  diagnosis, 
the  need  of  reasoning  closely  along  the  lines  of  distribution  of  the  nerves.  In 
this  case  Hilton  found  that  the  urine  was  affected,  that  it  was  ammoniacal,  and 
a less  skillful  physician  would  have  treated  the  case  for  bladder  trouble,  as  in- 
deed often  occurs.  The  point  I wish  to  make  is,  that  the  osteopath  must  not 
be  carried  astray  by  general  symptoms.  So  where  you  find  foul  urine,  pain  in 
the  bladder,  and  things  of  that  kind  you  may  be  led  astray ; you  surely  will  be 
if  you  are  not  one  who  knows  his  business.  It  is  the  dictum  of  one  of  the 
old  schools,  I do  not  know  which,  to  “Watch  the  symptoms  carefully  and  treat 
them  as  they  arise.”  And  that  has  seemed  to  be  the  practice  followed.  But 
it  does  not  need  much  reasoning  to  show  you  that  should  an  osteopath  adopt 
such  a course,  he  would  rapidly  become  a failure  in  his  chosen  profession. 
There  was  a ease  here  some  time  ago — a young  man  from  Springfield,  111., 
came  here  with  one  leg  shorter  than  the  other.  He  used  crutches ; he  had  a 
severe  pain  on  one  side  of  the  knee  of  the  affected  limb.  That  man  had  trav- 
eled extensively  seeking  help.  He  had  been  massaged  and  treated  in  almost 
every  conceivable  way;  had  lived  in  the  hospitals  for  months.  But  one  day  he 
said  to  the  physician  in  charge,  “How  does  it  happen  that  that  leg  is  shorter? 
What  is  the  trouble  with  that  knee?”  “Well,”  he  said,  “The  bones  may  be 
separated  and  the  tibia  may  have  been  pushed  up,  thus  shortening  that  limb.” 
If  I remember  correctly  that  case  was  cured  practically  in  one  treatment.  I do 
not  say  this  to  illustrate  our  quick  cures.  The  treatment  was  sufficient  be- 
cause the  muscles  had  been  massaged,  and  were  softened  and  ready  to  be  work- 
ed upon.  The  hip  was  set.  I became  acquainted  with  the  young  man  later. 
I realized  what  it  was  to  have  the  deformity  cured.  He  had  been  treated  for 
years  for  the  knee,  but  the  trouble  was  in  the  hip.  This  is  almost  a threadbare 
illustration  of  what  osteopathy  does,  but  it  illustrates  my  point  here  perfectly. 
If  you  follow  up  the  symptoms  and  treat  them  as  they  arise,  you  will  land  in 
obscurity.  I do  not  wish  to  criticise  any  system  of  medicine,  but  from  our 
standpoint  it  will  not  do  for  an  Osteopath  to  work  in  that  way.  If  he  does, 
he  is  a poor  osteopath  and  does  not  understand  what  he  is  trjdng  to  do.  and 
simply  makes  what  the  “Old  Doctor”  calls  an  “engine  wiper”.  He  goes  after 
the  seat  of  pain,  and  not  the  seat  of  the  trouble,  and  simply  becomes  a masseur, 
and  in  his'  case  the  criticism  could  justly  be  made  and  that  is  some  times  claim- 
ed— that  osteopathy  is  nothing  but  massage. 

Dr.  Hildreth  brought  out  this  same  point  some  time  ago.  He  mentioned 
two  things  that  made  up  the  success  of  the  osteopath.  The  first  was  in  not  be- 
ing too  rough  in  our  treatment,  but  the  one  I want  to  call  your  attention  espec- 
ially to  was  that  osteopathy  makes  correct  diagnoses.  It  goes  back  to  the  or- 
iginal cause,  and  does  not  depend  upon  symptoms  merely. 

I wish  to  call  your  attention  to  the  following  point;  That  pain  upon  the 
surface  of  the  body,  not  accompanied  by  any  rise  in  temperature,  indicates  a 
distant  origin  of  the  trouble,  ami  that  trouble  is  usually  in  the  spine. 


20 


Hilton  says  that  if  this  local  pain  be  upon  the  entaneoiis  surface  then  it 
will  indicate  spinal  disease  in  every  case.  I have  had  a drawing  put  here 
showing  “a”  and  “b,”  the  distribution  respectively  of  the  6th  and  7th  dorsal 
nerves.  They  meet  over  the  pit  of  the  stomach  in  the  skin,  and  will  refer  a 
pain  to  that  point.  The  patient  thinks  the  trouble  is  there;  his  trouble  is  in- 
variably at  the  spine.  He,  of  course,  will  want  you  to  treat  the  affected  spot. 
There  is  a case  on  record  of  pain  in  the  pubes  and  over  the  lower  part  of  the 
abdomen ; the  physician  finding  the  trouble  in  the  lower  part  of  the  spine,  it 
being  associated  with  paralysis  of  the  lower  limbs,  decided  it  was  spinal  trouble 
and  rubbed  an  ointment  on  the  spine.  The  patient  thinking  the  symptoms 
should  be  treated,  rubbed  the  ointment  over  the  lower  part  of  the  abdomen, 
being  paid  for  his  interference  by  a gi’eat  deal  of  smarting.  He  wanted  to 
treat  the  seat  of  the  pain  instead  of  the  seat  of  Ihe  lesion.  It  is  true  that  these 
pains  are  not  mere  happen  so’s.  They  depend  upon  a close  connection,  as  in 
this  case,  of  the  nerves ; this  close  connection  may  be  either  through  the  spinal 
nerves  or  it  mav  be  through  the  sympathetic  system.  You  may  have  a pain  at 
a part,  which  you  may  trace  up  through  a nerve,  back  up  through  the  cord  to 
the  brain  or  center,  down  another  nerve  to  the  original  cause ; so  that  an  origi- 
nal cause  may  act  along  a nerve  through  a center  and  down  through  another 
nerve.  So  that  the  seat  of  the  pain  is  not  the  seat  of  the  lesion.  If  such  a 
patient  comes  to  you,  do  not  become  a masseur;  do  not  treat  the  seat  of  his 
pain,  but  treat  the  seat  of  the  lesion  causing  the  trouble,  and  convert  him  by 
showing  him  true  osteopathy. 

A peculiar  phenomenon  is  often  witnessed.  You  may  come  across  a case 
in  which  one  part  of  the  body  is  more  sensitive  than  another;  you  may  have 
paralysis,  both  muscular  and  sensory,  below  an  injured  part,  with  very  acute 
hyperesthesia  above.  The  explanation  which  has  been  given  in  such  a case  is 
two-fold.  In  the  first  place,  take  such  a case  as  a fracture  of  the  spine;  of 
course  the  parts  about  the  site  of  the  injury  are  the  seat  of  the  inflammation ; 
after  the  fracture  the  parts  are  engorged  with  blood,  there  are  exudations,  both 
fluid  and  cellular,  about  the  parts,  which  may  press  upon  the  origins  of  the 
nerves  just  above  the  seat  of  the  fracture  and  may  irritate  for  a considerable 
distance  up  in  the  spine,  thus  causing  considerable  sensation  above.  Below 
the  nerves  have  been  injured  by  the  trauma  to  the  cord.  The  other  explana- 
tion is  chiefly  the  same,  except  that  in  it  the  origin  of  the  spinal  nerves  is  tak- 
en into  consideration  ; as  you  go  further  down  the  spinal  column  you  will  find 
that  the  roots  run  more  and  more  obliquely  in  the  canal,  until  finally  the  lower 
ones  run  an  i nch  and  a half  or  an  inch  and  three-quarters  before  emerging. 
And  of  course  when  the  impingement  is  upon  the  origin  of  those  nerves,  the 
pain  will  be  at  their  distribution  upon  the  muscles  and  the  surface  of  the  body. 
I had  a ease  similar  to  this — a man  who  is  still  in  town  for  treatment.  He  has 
paralysis  of  the  lower  limbs,  almost  complete  lack  of  muscular  ability  and  also 


21 


almost  complete  lack  of  sensibility  m the  lower  limbs.  The  lesion  appears  to 
be  in  the  lower  part  of  the  spine.  I say  “appears  to  be,’’  because  there  is 
another  place  higher  up  in  the  spine  which  may  be  the  cause.  But  taking  it 
as  the  lower  one,  he  has  a terrible  itching  and  smarting  along  the  spine ; upon 
treatment,  however,  he  readily  recovers  from  these  symptoms  Now,  the  ex- 
planation may  be  similar  to  that  given,  and  it  may  partake  of  the  reasoning 
that  I gave  you  the  other  day  concerning  osteopathic  matters.  That  is,  that 
there  is  too  much  life  above,  and  there  is  too  little  life  below ; something  has 
interferred  to  cut  off  nerve  life  and  blood  flow  below,  while  that  above  is  sup- 
plied with  its  full  quota  already  and  does  not  need  that  which  is  misdirected 
to  it,  thus  there  is  irritation  to  the  jiarts  above  and  the  resulting  symptoms. 
What  the  osteopath  does  is  simply,  as  was  indicated  before,  to  try  to  restore 
the  equilibrium  of  nerve  and  bfood  forces  to  the  lower  parts  of  the  body  which 
are  suffering,  and  then  to  the  parts  which  are  impigued  upon  above.  To  do 
this  he  simply  goes  back  to  the  parts  affected. 

Q.  In  the  event  of  peripheral  trouble,  sensation,  would  you  also  find  the 
sensation  at  the  origin? 

A.  Not  necessarily.  You  might  not  have  any  sensation  there.  Other- 
wise, the  patient  would  have  himself  perhaps  discovered  it.  Y'ou  may  not 
have  a sore  spot  at  ail ; it  may  be  such  a lesion  as  spreading  of  the  spines  or 
approximation  of  the  spines,  not  necessarily  any  tenderness  at  the  central,  at 
the  lesion. 

Q.  Are  there  no  exceptions  to  the  rule  that  where  there  is  pain  on  the 
surface,  accompanied  with  rise  of  temperature,  the  trouble  is  of  spinal  origin  ? 

A.  I took  Hilton  as  the  authority  there,  and  he  gives  this  example.  It 
is  just  as  invariable  as  in  the  case  of  inflammation,  in  which  the  principal  sign 
is  rise  of  temperature,  yon  may  have  the  swelling  and  the  pain  without  the  in- 
flammation, blit  if  you  have  these  two  and  heat  also  it  is  a sign  of  inflamma- 
tion. He  makes  a parallel  and  says  it  is  just  as  invariable  that  if  there  is 
pain  upon  the  surface  of  the  body,  accompanied  by  rise  in  temperature,  the 
cause  is  of  spinal  origin ; he  does  not  make  any  exception. 

Q.  I understood  you  to  say  that  the  5th  nerve  was  reached  through  the 
sympathetic? 

A.  The  5th  cranial  is  reached  through  the  superior  cervical  ganglion. 
We  get  results  which  justify  us  in  saying  this;  any  operator  will  tell  you  that 
he  gets  results  from  the  superior  cervical  that  influence  the  5th  nerve.  Of 
course  he  does  it  by  sympathetic  connection,  which  I will  explain  at  another 
time. 

Q.  In  the  ease  of  that  man  with  the  pain  on  the  inside  of  the  knee,  sup- 
pose that  he  should  have  had  localized  trouble  at  the  knee,  would  yon  have 
recognized  the  condition  by  the  lesion  in  the  spine? 

A.  Yes,  partly,  and  yon  would  have  to  go  into  the  history  of  the  case. 


22 


You  would  have  to  go  back  to  your  centres  and  determine  what  was  the  trouble. 

The  first  thing  would  be  to  go  to  the  spine  and  thoroughly  examine ; if  you 
find  a lesion  there,  the  probabilities  are  it  is  of  spinal  origin.  Y"ou  should  by 
all  means  whenever  you  have  such  a case,  or  any  case,  go  back  to  the  center  of 
the  nerve  suppl.>,  and  you  may  find  the  lesion  there,  above  or  below  the  center, 
or  you  may  not  have  a distinguishable  lesion. 

Q.  In  the  event  of  a severe  gastritis  would  there  be  a soreness  in  the 
spinal  region  ? 

A.  Very  likely  there  would  be,  and  in  that  case  your  soreness  and  con- 
gestion of  the  muscles  would  be  what  I have  explained  as  secondary. 

Q.  Which  would  be  secondary  ? 

A.  The  congestion  of  the  muscles  along  the  spine.  In  a case  of  sevei'e 
gastritis  you  would  very  likely  find  sore  spots  along  the  spine.  The  explana- 
tion being  that  the  nerve  influence  from  the  disturbed  stomach  travels  along 
the  sympathetic  branches  of  the  solar  plexus  back  to  the  spinal  connection  of 
those  nerves,  and  then  passed  through  to  the  peripheral  termination  of  the 
spinal  nerves  in  the  muscles  of  the  back. 

Q.  Is  it  true  that  5^11  can  designate  which  organ  of  the  body  is  in  trouble 
by  finding  the  tenderness  in  certain  spots  in  the  spine? 

A.  Yes,  in  general  that  is  true.  I thought  I brought  that  point  out  in 
my  last  lecture.  The  sore  spots  may  be  due  to  either  peripheral  or  central 
trouble,  and  by  determining  whether  they  are  primary  or  secondary  you  may 
locate  the  trouble  by  reasoning  from  the  center  to  the  periphery. 


LECTURE  VI. 


At  the  last  lecture  I called  your  attention  to  the  further  significance  of 
the  clicking  in  the  neck,  stating  that  it  frequently  meant  a lack  of  lubrication 
secreted  in  the  synovial  membranes.  I began  to  take  up  the  general  effects 
of  lesions  of  plexuses  along  the  spine,  taking  up  the  first  group,  the  upper 
four  cervical  nerves.  I called  your  attention  to  the  fact  that  pain  must  be 
referred  to  the  origin  of  the  nerve  supplying  a part,  instancing  the  anterior 
pendulous  portion  of  the  ear  and  the  posterior  portion  of  the  ear  as  being 
suiiplied  by  the  second  cervical  nerve,  versus  pain  in  the  other  parts  of  the 
ear  indicating  lesion  in  the  fifth  cranial  nerve.  Hilton  considers  disease  of 
the  upper  cervical  ijortiou  of  the  spine  among  those  most  dangerous  to  life. 
The  operator  must  not  confuse  symifloms  wuth  causes.  He  must  not  take, 
for  instance,  some  synitom  which  may  be  prominent,  thinking  it  to  be  one  of 
the  first  causes.  If  there  is  pain  upon  the  surface  of  the  body  not  accom- 
panied by  any  rise  in  temperature,  it  indicates  disease  of  the  spinal  region. 
A peculiar  phenomenon  often  witnessed  is  that  there  is  paralysis  of  sensation. 


or  motion,  or  both,  at  a point  below  a spinal  injnry,  while  there  is  acnte 
hyperesthesia  just  above.  The  explanation  was  given  that  it  was  ovTng  in 
part  to  the  obliquity  of  the  course  of  the  spinal  nerves,  in  part  to  the  en- 
gorgement of  the  parts  and  the  exudations,  fluid  and  cellular,  which  takes 
place  around  a serous  lesion  of  the  spinal  cord.  To-day  I wish  to  piu’sue 
this  line  of  thought  somewhat  further,  hoping  to  finish  it  in  this  lecture.  That 
is,  this  general  point  of  the  significance  of  general  symptoms  to  the  Osteo- 
path. 

1.  Further  consideration  of  Osteopathic  significance  of  points  found  in 
diagnosis. 

The  lower  four  cervical  nerves  and  the  brachial  plexus  constitute  what 
is  known  as  the  second  group  of  nerves.  The  brachial  plexus  sends  short 
branches  to  the  shoulder  and  upi^er  intercostal  muscles,  and  long  branches  to 
the  arms.  In  general  the  effects  which  may  follow  lesions  to  the  second 
group  of  nerves  are  paralysis,  spasms  and  neuralgias.  Such  troubles  the 
operator  must  learn  to  refer  back  to  the  center;  that  is,  to  the  origin  of  the 
plexus  along  the  spine.  Should  you  have  palsy  of  the  hand,  or  edema  which 
is  neurotic  in  origin,  such  cases  you  must  refer  to  trouble  in  the  brachial 
plexus.  Of  course  this  is  speaking  of  these  nerves  as  members  of  the  cere- 
bro-spinal  system.  Please  remember,  also,  that  the  first  group  of  nerves  is 
connected  with  the  upper  cervical  ganglion  of  the  sympathetic,  and  that  the 
second  group  of  nerves  is  connected  with  the  second  and  third  ganglia  of  the 
sympathetic,  and  that  in  case  the  lesion  be  severe  enough  to  affect  sympathe- 
tic life,  you  may  in  lesions  in  this  region  have  far-reaching  disturbances.  Ee- 
member  also  that  from  the  third,  fourth  and  fifth  cervical  nerves  arises  the 
phrenic  nerve,  and  that  injiuy  here  may  cause  diaphragmatic  trouble,  hic- 
coughs for  instance,  which  we  treat  in  that  region. 

The  third  group  of  nerves  is  composed  of  the  twelve  dorsal  nerves.  Of 
these  the  first  six  are  connected  with  the  first  six  dorsal  ganglia  of  the  sym- 
pathetic, and  the  last  six  but  one  are  connected  with  the  remaining  six  dor- 
sal ganglia  of  the  symi^athetic.  In  their  capacity  as  spinal  nerves  the  mem- 
bers of  this  third  group  are  subject,  usually,  to  merely  .sensory  affections. 
Thus  yon  will  frequently  come  across  in  your  practice,  cases  of  intercostal 
neuralgia.  This  the  Osteopath  diagnosis,  and  is  usually  correct,  as  a pres- 
sure upon  the  nerves,  caused  by  crowding  together  of  the  ribs.  Later,  when 
we  come  to  take  up  the  consideration  of  the  thorax,  you  will  find  that  we 
make  prominent  the  point  that  the  ribs  are  dropped  together  frequently  or 
are  drawn  together,  and  you  will  learn  to  reason  thus,  as  in  the  case  of  in- 
tercostal neuralgia,  from  the  Osteopathic  point  of  view.  Lesions  here  may 
also  cause  herpes  zozter,  commonly  called  shingles,  a nervous  affection  ac- 
companied by  eruptions  upon  the  skin.  From  their  sympathetic  connections 
this  group  of  nerves  may  be  associated  with  troubles  of  the  pleura  or  Imigs. 


24 


and  with  syiupathetic  troubles  of  the  viscera,  as  yon  know  the  splanchnic 
nerves  run  from  the  sympathetic  connections  of  the  dorsal  nerves  to  the  vari- 
ous viscera  of  the  body. 

The  fourth  group  of  nerves  is  composed  of  the  five  lumbar  nerves,  the 
ui)j)er  four  of  these  nerves,  with  the  twelfth  dorsal  are  connected  with  the  five 
lumbar  ganglia  of  the  sympathetic.  Diseases  which  may  affect  these  nerves 
as  members  of  the  cerebro  spinal  system  are  mainly  neuralgic.  Of  course 
you  may  have  paralysis  or  spasms,  but  you  are  not  so  liable  to  have  them  as 
in  lesions  of  the  nerves  of  the  cervical  or  sacral  region.  Sympathetic  troubles 
of  course  would  occur  according  to  the  centers  with  which  these  nerves  are 
connected. 

The  fifth  group,  finally,  is  that  composed  of  the  five  sacral  nerves.  These 
five  sacral  nerves,  with  the  fifth  lumbar,  are  connected  with  the  five  sacral 
ganglia  of  the  sympathetic.  Lesions  affecting  these  spinal  nerves  are  such  as 
affect  the  cervical  nerves  in  general,  that  is,  paralysis,  spasms,  and  neu- 
ralgias, which  may  vary  greatly  in  character.  You  may  have  tonic  or  clonic 
spasms  of  the  lower  limbs;  you  may  have  nem-algia,  such  as  sciatica;  or  you 
may  have  paralysis  of  the  lower  limbs.  Sympathetically,  of  coui-se,  you 
would  refer  to  such  troubles  as  are  indicated  in  the  outline  of  centers  given. 

I have  thus  taken  ui)  the  grouping  of  the  nerves  along  the  spine.  Of 
course  it  has  been  very  general.  The  purpose  has  been  to  give  you  a general 
view  of  regions  affected,  and  to  give  you  a general  idea  of  how  the  Osteopath 
looks  at  disease;  that  is,  he  reasons  from  perij)hery  back  to  center.  My  treat- 
ment of  the  subject  has  necessarily  been  general,  leaving  aside  a more  particu- 
lar view  until  such  time  as  we  shall  take  up  these  different  effections  which 
we  meet,  more  in  detail.  I may  in  these  last  few  lectures  have  been  a trifle 
obscure;  I find  it  a rather  difficult  subject  to  elaborate  and,  being  so  general, 
it  may  have  been  indefinite.  Still  I trust  it  may  have  fulfilled  its  object, 
which  was,  briefly,  as  follows:  In  the  first  place,  to  indicate  to  you  the  ne- 

cessity of  keeping  separate  in  your  mind  the  cerebro-spinal  system  and  the 
sympathetic  system.  Eemember  that  you  cannot  separate  these  entirely,  but 
look  for  symptoms  from  the  one  and  look  for  symptoms  from  the  other,  one 
is  a eerebro-siiiual  view  and  the  other  a sympathetic.  You  do  not  really  find 
them  so  separated  in  your  practice.  Second,  to  impress  you  with  the  im- 
portance of  diagnosis  based  according  to  the  centers  affected.  Third,  to  teach 
yon  not  to  confound  incidentals  with  essentials;  not  to  mix  mere  symptoms 
with  causes  of  disease.  I thought  I could  thus  indicate  to  yon,  that  Osteo- 
pathic point  of  vieAv,  that  Osteopathic  habit  of  mind  in  looking  at  disease. 

Hilton  states  that  as  a ride  pain  in  disease  of  the  lower  cervical,  dorsal 
and  lumbar  regions  is  indicated  by  pains  symmetrically  upon  the  surface  of 
the  body.  That  in  the  upper  cervical  region  being  not  indicated  symmeti’ical- 
ly  by  pain  upon  the  sui-face  of  the  body.  The  original  cause  for  such  pains 


we  would  look  for,  of  course,  iu  a central  lesion.  If  the  trouble  be  bi-lateral, 
located  on  each  side  of  the  body,  we  would  look  for  a central  cause,  or  per- 
haps the  cause  may  be  bi-lateral.  I instanced  a case  at  the  last  lecture  of 
pain  over  the  skin  at  the  pit  of  the  stomach,  being  referred  back  along  the 
course  of  the  nerves  to  the  sixth  and  seventh  dorsal  vertebrte.  Hilton  in- 
stances a case  in  which  a boy  had  severe  pain  there;  he  went  about  stooping, 
holding  his  hands  over  that  region.  Upon  lying  down  the  pain  disappeared 
to  some  extent.  His  diagnosis  of  that  case  was  that  there  was  trouble  at  the 
sixth  and  seventh  vertebrae,  and  he  found  disease  there  of  such  natui’e  that  it 
exerted  pressure  upon  tlie  sixth  and  seventh  nerves  upon  both  sides.  An- 
other case  similar,  was  more  complicated  in  that  it  lead  to  vomiting.  Almost 
any  physician  would  have  diagnosed  such  a case  as  stomach  trouble,  no 
doubt,  Hilton,  however,  upon  examining  the  tongue  found  no  indications  of 
stomach  trouble,  and  diagnosis  that  case  also  as  disease  of  the  sixth  and  sev- 
enth vertebrm,  directed  treatment  to  those  points,  and  was  successful  in  cur- 
ing the  case.  Sometimes  in  such  diseases  we  find  a pinching  feeling  about 
the  body,  a feeling  as  if  the  body  were  girdled.  Uow,  as  to  the  reason  why 
these  pains  are  symmetrical  in  these  parts  of  the  body  I have  already  indi- 
cated. But  why  they  do  not  occur  so  above  is  simply  this:  The  difference 

in  the  nature  of  the  vertebrm.  Thus,  below  the  second  cervical,  the  vertebrje 
articulate  with  each  other  by  their  bodies  and  articular  processes,  but  above 
that  point  it  is  different;  the  atlas  articulating  with  the  occiput  by  just  two 
points,  and  one  might  be  affected  without  communicating  with  the  other. 
The  articulation  of  the  atlas  with  the  axis  is  by  just  three  points;  the  odon- 
toid process  articulates  with  the  anterior  arch  of  the  atlas,  and  the  bodies  by 
the  articular  surfaces.  Now,  any  one  of  these  may  be  affected,  and  it  is  the 
rule  that  one  of  these  is  affected  without  communicating  the  disease  to  the 
other.  Thus  you  may  have  a symmetrical  distribution  of  the  pain.  A further 
point  of  importance  is  that  if  a certain  organ  is  affected  the  impulse  may  be 
transmitted  sympathetically  from  it  and  refiectetl  to  another  organ,  and  that 
always  in  such  a case  it  is  carried  to  that  oi’gan  connected  most  closely  by 
nerve  strands  to  the  organ  first  affected.  Byron  Eobinson  says  that  ganglia 
of  the  sympathetic,  especially  the  cervical  ganglia  and  the  abdominal  brain, 
are  points  of  reorganization  of  impulses  sent  to  them,  and  of  redistribution  of 
these  reorganized  infiuences  or  impulses,  which  are  sent  to  various  viscera,  iu 
general,  to  those  most  closely  connected,  those  which  are  furnished  with  the 
greatest  number  of  nerve  filaments.  I ({uote  from  him  as  follows:  ‘Tt  is  a 

principle  in  physiology  that  when  a peripheral  irritation  is  sent  to  the  ab- 
dominal brain,  the  reorganized  forces  will  be  emitted  along  the  lines  of  least 
resistance,  so  that  the  organ  which  is  supplied  with  the  greatest  number  of 
nerve  strands  will  suffer  the  most.”  He  cites  here  a prominent  instance  of 
uterine  tumor  affecting  the  heart,  and  iu  this  way,  that  the  influence  of  the 


26 


uterine  tumor  upon  the  li;\"i>ogastric  plexus  'was  reflected  back  through  the 
solar  plexus,  where  it  was  reorganized  and  sent  out  along  the  splachnics  to 
the  superior  cervical  ganglion  and  the  next  two  below  it,  and  was  then  sent 
out  along  the  three  cardiac  branches  to  the  heart,  thus  causing  an  irregularity 
of  the  heart,  leading  finally  to  heart  disease.  This  i)oint  is  of  great  importance 
to  the  Osteopath.  You  will  find  it  very  common  in  your  practice  to  find  a 
case  of  uterine  trouble  resulting  in  headache.  Thoroughly  api^ly  any  of  the 
ordinary  methods  of  treatment  to  the  headache,  and  they  will  certainly  be  un- 
successful. You  must  learn  to  diagnose  with  these  things  in  mind,  and  to 
reason  according  to  the  connection  of  these  parts  through  the  sympathetic 
system.  Yow,  in  the  instance  given,  the  impulse  might  have  been  sent  dif- 
ferently. It  might  have  passed  from  the  hypogastric  plexus  to  the  solar 
plexus,  being  there  reorganized  and  then  sent  out  to  other  viscera  throughout 
the  body,  as  is  frequently  the  case.  Or  it  might  have  run  up  through  the 
sympathetic  cord,  reaching  the  medulla,  then  affecting  the  vagi  nerves,  re- 
sulting in  stomach  trouble.  Another  illustration  I take  from  him.  He  calls 
to  mind  the  fact  that  the  kidneys,  ovaries,  uterus  and  falloi^ian  tubes  of  the 
female  are  developed  from  the  ^Yolfiian  bodies  in  the  embryo.  They  are  thus 
closely  connected  in  nerve  and  blood  suj)i3ly,  and  it  is  a fact  that  uterine 
trouble  results  often  in  kidney  trouble,  and  kidney  trouble  may  very  readily 
result  in  uterine  trouble.  In  such  a case  it  is  difficult  to  diagnose  the  case 
according  to  the  symptoms,  and  to  determine  what  must  be  the  original  cause. 
These  secondary  symj>toms  are  frequently  quite  prominent,  and  treatment 
directed  to  them  will  not  necessarily  have  any  effect  upon  the  original  trouble. 

II.  Landmarks  concerning  the  scapula.  Holden  instances  the  following- 
points  concerning  the  scapula.  First,  that  it  covers  the  ribs  from  the  second 
to  the  seventh  inclusive  on  either  side;  that  its  superior  angle  is  beneath  the 
trapezius  muscle;  that  its  inferior  angle  is  beneath  the  latissimus  dorsi  mus- 
cle; this  latissimus  dorsi  binds  the  posterior  edge  of  the  scapula  closely  down 
against  the  posterior  chest- wall  in  a strong  person.  In  case  of  consumptives 
the  scapula  is  allowed  to  project  outward  at  its  lower  angles,  and  this  gives 
the  peculiar  appearance  which  is  called,  ‘‘scapulre  alatte.”  A horizontal  line 
from  the  sixth  dorsal  spine  to  the  inferior  angle  of  the  scapula  outlines  the 
superior  margin  of  the  latissimus  dorsi  muscle.  A line  drawn  from  the  root 
of  the  spine  of  the  scapula  down  to  the  twelfth  dorsal  spine  outlines  the  in- 
ferior burder  of  the  trai)ezius  muscle.  In  examining  a back  it  is  convenient 
to  have  the  patient  sit  leaning  forward  with  the  hands  hanging  between  the 
thighs;  this  brings  the  superior  angle  of  the  scapula  down  about  the  third  in- 
tercostal si)ace,  about  on  a level  with  the  fissure  between  the  upper  and  lower 
lobes  of  the  lung. 

III.  Hq-^'  to  Treat  a Spine: — Having  learned  how  to  examine  a spine, 
having  learned  also  the  significance  of  points  one  finds  along  the  spine  in  his 


27 


examination,  the  next  question  naturally  is,  how  to  treat  these  points  when 
oDserved.  I am  indebted  to  Dr.  Eastman  for  calling  my  attention  to  the  fact 
that  often  these  noises  which  we  may  find  in  treating  along  the  spine  are 
of  peculiar  significance  in  this  way : That  he  says  he  has  often  pushed  ribs 

back  into  place  which  had  been  slipped,  simply  by  this  pushing  motion  along 
the  spine.  In  our  treatment  of  a spine  there  are  two  points  which  we  may  take 
into  consideration  ; two  objects  which  we  may  have  in  view.  In  the  first  place, 
we  may  wish  to  treat  the  spine  per  se,  treat  the  spine  itself.  In  the  second 
place,  we  may  wish  to  reach,  by  treating  the  centers  along  the  spine,  the  viscera 
to  which  these  nerves  run.  It  is  not  always  possible  to  diassoeiate  these  in 
your  practice.  Indeed,  this  is  more  a separation  of  convenience.  I have  di- 
vided these  points  thus  simply  for  convenience  in  the  consideration  of  them. 
You  will  of  course,  in  practice  not  be  able  to  separate  the  results  upon  the 
spine  itself  from  the  result  which  you  will  get  upon  the  centers  when  working 
along  the  spine,  but  the  Osteopathy  of  it  is  the  same,  and  I trust  will  be  made 
clear  to  you  by  this  division. 

Now,  when  you  are  treating  a patient,  one  very  good  way  to  treat  the 
spine,  to  get  everything  relaxed,  is  simply  to  lay  the  patient  on  his  face.  The 
patient  usiiallv  thinks  he  is  relaxed  when  he  may  not  be.  I think  those  of  you 
who  are  familiar  with  Delsarte  methods  will  agree  with  me.  Your  first  care  is 
to  see  that  the  patient  has  become  fully  relaxed.  Now,  we  wish  to  learn  how  it 
is  that  we  may  affect  the  centraldistribution  of  the  sympathetic  nerve.  I spoke 
to  you  the  other  day  of  the  gray  rami  communicantes  extending  from  the  gan- 
glia of  the  sympathetic  back  to  the  spinal  column,  supplying  the  blood  vessels 
of  the  dura  mater  of  the  vertebrae,  and  the  ligaments.  Thus,  if  you  wish  to 
treat  the  spine  itself,  wish  to  strengthen  it,  of  course  you  must  necessarily  di- 
rect your  treatment  to  reaching  these  vaso  motor  nerves  in  order  to  relax  and 
allow  sufficient  nutriment  to  be  sent  to  these  parts.  In  order  to  do  this  you 
must  always  first  loosen  all  the  contractions  of  the  muscles  along  the  spine. 
Very  frecpiently  you  will  find  that  the  muscles  are  contracted  unevenly  and  slip 
under  your  fingers.  That  is  a test;  a muscle  may  be  hard,  as  it  naturally  is, 
from  exercise;  then  the  hardness  is  homogenous.  The  first  point,  then,  is  to 
loosen  up  the  muscles,  and  in  doing  this  it  is  M^ell  to  bear  in  mind  that  you 
must  work  against  the  course  of  the  muscle  fibres,  the  deeper  ones  especially. 
It  is  perhaps  easier  in  that  way  to  get  a relaxed  effect,  and  your  idea  should 
be  to  work  in  such  a way  as  not  to  hurt  the  patient.  You  may  treat  so  hard 
and  so  roughly  as  to  damage.  The  motions  that  I may  make,  or  the  faces  that 
Dr.  Hildreth  makes  when  he  is  treating  a patient,  are  not  any  indication  of 
the  amount  of  force  used,  that  is  a habit,  and  the  thing  you  should  guard 
against  is  too  rough  treatment,  as  you  may  injure  delicate  parts.  In  seeking 
to  relax  a nerve  you  may  harden  it,  and  thus  cause  the  muscle  to  shrink.  You 
should  not  manipulate  with  the  tips  of  the  fingers,  you  should  turn  the  fingers 


28 


so  that  the  cushion  of  the  finger  does  the  work,  and  in  that  wav  thoroughly  re- 
lax all  the  congested  or  contracted  muscles  along  the  spine?  What  if  you  do 
not  have  any  contracted  muscles  there?  That,  of  course  is  the  condition  in 
many  cases.  It  is  our  work  in  such  a case  where  the  muscles  are  flabby  and 
there  is  a lack  of  tone,  to  stiinlate  all  along  the  spine,  and  thus  to  tone  up  the 
parts.  Do  not  be  afraid  of  being  thorough  in  this  matter.  You  must  relax 
all  the  muscles  there  from  the  occiput  to  the  coccyx,  as  they  may  any  of  them 
produce  sympathetic  troubles  which  may  be  reflected  over  a considerable  por- 
tion of  the  body. 

There  is  a certain  amount  of  hair  splitting  done  over  the  terms  of  desensi- 
tization and  stimulation.  Their  significance  I will  take  up  later,  but  always  bear 
in  mind  that  your  first  point  must  be  to  relax  contracted  muscles  if  you  find 
them;  if  you  do  not,  your  work  should  be  directed  towards  reaching  the  deeper 
structures  mechanically  and  securing  an  ecpal  distribution  of  nerve  force.  If 
there  are  eoncontractions,  no  matter  what  your  final  treatment  is  to  be,  you 
must  get  rid  of  those  contractions  first.  While  the  patient  is  upon  his  face  there 
is  an  important  effect  which  we  get  upon  the  spine  itself.  Of  course  we  cannot 
separate  this  really  in  our  prctice  ; that  is,  the  work  along  the  spine  has  its  effect 
upon  the  body  according  to  the  centers  reached.  Suppose  I wish  to  reach  the 
center  going  to  supply  the  nutrition  of  these  parts,  I spring  the  spines  up, 
using  the  arm  as  a lever,  and  by  so  doing  you  can  exert  a great  deal  of  force. 
Drawing  up  the  arm  raises  the  ribs,  and  at  the  same  time,  by  springing  the 
spine  up,  I can  get  a considerable  force  all  along  the  spine.  This  is  one  way. 
Another  way  is  to  draw  the  limbs  up  ; you  will  find  this  a very  convenient 
method,  this  of  course  will  bow  the  back  and  make  prominent  the  spines,  then 
you  can  readily  reach  under,  and  in  that  way  you  can  spring  the  spine  or  any 
part  of  it ; and  it  is  always  advisable  for  you  to  stretch  the  spine  in  that  way 
rather  than  to  attempt  to  stretch  the  patient  by  pulling  the  neck ; that  is  a ten- 
sile strain  upon  the  spinal  column,  and  of  course  it  resists  more  than  it  does 
a lateral  force.  You  will  find  this  useful  in  your  practice.  There  is  another 
method  which  we  frequently  use,  getting  one  elbow  down  against  the  upper 
edge  of  the  pelvis,  and  the  other  against  the  prominent  part  of  the  shoulder, 
and  separating  them,  also  reacing  over  the  spines  of  the  vertebre,  you  relax 
all  along  the  spine.  When  you  have  done  this  upon  one  side,  repeat  it  on  the 
other.  And  why?  Because  when  you  spring  the  spine  in  this  way  all  along, 
you  have  stretched  the  ligaments  upon  that  side,  but  you  have  not  stretched 
the  others.  You  can  readily  see  that  as  I spring  these  spines  the  effect  must 
be  to  stretch  the  ligaments  on  the  convex  side,  and  to  relax  the  ligaments  up- 
on the  concave  side  of  the  curve.  So  you  must  turn  the  patient  over,  treat  the 
other  side,  providing  you  wish  to  reach  the  ligaments  upon  both  sides  of  the 
spine.  You  maj'  treat  the  muscles  alone  in  this  way.  When  you  have  that 
object  in  view,  which  depends  upon  your  case,  usually  you  must  exert  cousid- 


29 


erable  force,  but  do  not  dig.  Do  not  use  the  end  of  your  finger.  You  can  de- 
velop strength  so  that  you  can  keep  the  fingers  flat  and  work  with  the  cushion 
of  the  fingers  against  the  muscle,  and  in  this  way  you  can  get  a very  good  ef- 
fect upon  the  muscles  themselves.  Do  not  be  afraid,  but  keep  at  it  until  they 
are  relaxed ; do  not  treat  too  hard  or  you  may  stimulate,  and  they  will  con- 
tract more,  but  by  deep  work  along  the  spine  you  may  have  a soothing  effect 
upon  those  nerves  and  thus  cause  them  to  relax.  What  has  been  the  object 
of  this  work?  Simply  this,  that  by  relaxation  of  the  contracted  muscles  or 
by  stimulation  of  those  weak,  flabby  muscles,  you  have  succeeded  in  drawing 
new  life  to  that  spinal  column,  and  in  that  way  have  made  your  first  step  to- 
wards reinstating  the  strengh  of  that  debilitated  spinal  column. 

Q.  Is  a simple  manipulation  there  enough  to  relax  the  contracted  mus- 
cle? 

A.  Yes,  simple  manipulation  is  enough  if  rightly  applied. 

Q.  Is  a dislocation  of  a vertebra  liable  to  cause  giddiness? 

A.  It  may  very  readily.  It  may  act  in  such  a way  as  to  shut  off  the 
blood  supply  to  the  brain. 

Q.  More  likely  the  cervical  vertebrae? 

Y.  Yes,  more  likely  in  the  cervical  region.  Or  it  might  act  in  such  a 
way  as  to  cause  retention  of  the  blood  in  the  head  and  result  in  dizziness. 

Q.  Did  Dr.  Eastman  say  that  a rib  displaced  was  the  cause  of  a noise 
along  the  spine  ? 

A.  As  he  pushed  the  rib,  and  as  it  went  back  into  place  it  made  the 
noise. 

Q.  If  you  had  a patient  who  was  unable  to  raise  his  hands  above 
the  level  of  the  shoulder,  and  there  was  pain  at  the  insertion  of  the 
deltoid  muscle  and  also  over  the  shoulders,  where  would  you  look  for  the 
trouble  ? 

A.  I would  look  for  the  trouble  in  the  brachial  plexus,  the  origin  of  the 
circumflex  nerve,  supplying  the  deltoid  muscle. 


LECTURE  VII. 


At  the  last  lecture  I took  up  further  consideration  of  the  Osteopathic 
significance  of  points  found  in  diagnosis.  I called  your  attention  to  the  trou- 
bles which  may,  in  general,  effect  the  low^er  cervical  group  of  nerves:  those 
which  affect  the  brachial  pilexus,  for  instance,  being  chiefly  spasms,  neural- 
gias and  paralysis.  Also,  I called  your  attention  to  the  connection  between 
those  nerves  and  the  sympathetic  ganglia;  also  the  connection  of  the  third 
group,  the  dorsal  nerves,  except  the  tw^elfth,  wuth  the  sympathetic  dorsal 
ganglia;  the  diseases  of  this  group  being  chiefly  sensory.  I then  spoke  of 


30 


the  connection  of  the  fourth  groufi,  the  upper  four  lumbar  nerves  and  the  last 
dorsal,  being  connected  with  the  five  lumbar  ganglia  of  the  sympathetic;  the 
diseases  of  the  fourth  group  being  chiefly  neuralgias,  and  not  spasms  or  par- 
alysis, although  you  might  find  them  in  that  group.  Spasms  and  paralysis, 
as  well  as  neuralgia,  being  more  commonly  found  in  the  fifth  group;  the  five 
sacral  nerves  and  the  last  lumbar  being  connected  with  the  sacral  sympathe- 
tic ganglia.  I also  traced  in  general  the  connection  between  these  plexuses 
and  diseases  which  might  originate  there,  stating  that  my  object  in  the  last 
two  lectures  had  been  to  aid  you  to  keep  separate  the  cerebro- spinal  and 
sympathetic  systems,  to  diagnose  diseases  according  to  centers,  and  to  teach 
you  to  separate  non-essentials  from  essentials.  I instanced  this  rule  of  nerve 
force,  that  it  is  emitted  along  the  path  of  least  resistance,  and  that,  sympathe- 
tically, the  organ  most  closely  connected  by  nerve- strands  with  the  organ  af- 
fected is  most  apt  to  suffer;  that,  in  the  sending  of  such  impulses  along  the 
paths  of  the  sympathetic  system,  certain  centers,  such  as  the  abdominal 
brain,  are  centers  for  reorganization  of  those  impulses,  so  that,  being  re- 
flected to  these  centers,  they  are  sent  out  reorganized.  I then  drew  some  il- 
lustrations to  account  for  phenomona  witnessed  according  to  this  law.  I then 
called  your  attention  to  landmarks  concerning  the  scapula,  and  to  treatment 
of  the  spine.  That  being  the  question  you  naturally  ask  after  having  learned 
to  examine  the  spine.  The  general  points  brought  out  being  that  there  is  a 
treatment  upon  the  spine  itself,  and  a treatment  of  the  spine  for  further  reach- 
ing effects,  chiefly  through  the  sympathetics,  upon  the  internal  viscera.  And 
I showed  you,  by  laying  the  patient  upon  his  face  and  upon  his  side,  what 
was  the  technique  of  manipulation  that  we  employ.  I shall,  in  the  latter  part 
of  this  lecture  continue  that  subject.  I have  tnought  that  for  the  first  part 
of  my  lecture  to-day  it  would  be  helpful  to  us  to  consider  the  Osteopathic 
theory  of  work  upon  centers. 

I.  How  does  the  Osteopath  by  external  manipulation  upon  the  surface 
of  the  body  affect  internal  nerve  life?  How  can  he  reach  centers  in  the  spine, 
or  nerve  centers  in  any  part  of  the  body?  ATiat  does  the  Osteopath  mean 
when  he  says  that  he  stimulates,  or  desensitizes,  or  inhibits  nerve  action? 
Those  are  great  questions.  It  is  needless  for  me  to  say  to  you  that  they  lie 
at  the  basis  of  our  science.  It  is  not  a question  as  to  fact.  The  facts  are  al- 
ready proven  beyond  a doubt,  but  it  is  a question  of  finding  a rational 
scientific  explanation  of  facts;  of  establishing  theories  which  lie  back  of  our 
work.  Osteopaths  have  different  views  concerning  these  matters.  They 
answer  these  questions  differently.  I called  upon  the  different  operators  in 
the  building  to  give  me  a synopsis  of  what  their  views  were.  There  were 
some  who  said  they  were  not  able  to  explain  satisfactorily  some  of  these 
things,  and  there  was  also  some  disagreement  in  their  answers.  I simply 
wish  to  add  my  little  mite,  not  at  all  supposing  that  it  will  solve  the  ques- 


31 


tiou  for  all  time.  There  are,  however,  certain  facts  in  relation  to  these  ques- 
tions which  I think  it  will  be  profitable  to  call  to  your  attention,  and  I will 
also  make  some  reference  to  the  answers  which  I have  received  from  the  old 
operators  whose  experience  has  been  wider  than  mine.  Eemember,  it  is  not 
a question  of  “Do  you  do  this?  Do  you  accomplish  such  results?”  but 
granted  that  the  results  are  accomplished,  which  is  true,  “how  do  you  accom- 
idishthem?”  In  approaching  this  question  we  must  clear  away  all  misap- 
prehension as  to  definition.  Do  we,  when  we  say  “desensitization.”  etc., 
mean  the  same  as  the  physiologists  mean  when  they  say  desensitization, 
stimulation,  etc.,  and  can  we,  in  the  generally  accepted  view,  have  such  an 
effect  upon  the  nerve  as  to  desensitize  or  stimulate  them?  For  this  reason  I 
will  first  define  these  points  according  to  the  j^hysiological  view,  and  then  ac- 
cording to  the  osteopathic  view.  The  physiologist  uses  these  terms  in  two 
senses.  First,  in  the  usual  normal  sense;  a normal  impulse  sent  from  a cen- 
ter along  a nerve  or  from  a periphery  along  the  nerve,  resulting  in  function. 
For  instance,  an  impulse  is  sent  from  the  brain  along  a nerve  causing  the 
contraction  of  a muscle.  Again,  a sensation  of  pain  comes  from  the  periphery 
to  the  center,  which  thus  receives  it,  and  there  is  a sense  of  x>ain.  In  this 
case  there  was  a stimulation  of  a sensory  nerve  by  the  agency  i^roducing  the 
I)ain,  no  matter  what  that  agency  was.  For  instance  again,  the  normal  and 
continuous  inhibition  of  cardiac  action  through  the  vagi  by  the  impulse  sent 
from  the  brain.  Now,  that  is  the  normal  and  usual  sense  in  which  these 
terms  are  used.  The  second  sense  in  which  these  terms  are  used  by 
physiologists  is  irritation  of  a nerve,  and  thus  its  stimulation  or  inhibition  of 
function  by  physical  agencies,  as  heat,  cold,  electric  current,  application  of 
pressure  or  tapping,  or  the  application  of  chemicals.  That  is^what-he  usually 
means  when  he  says  he  has  acted  upon  a nerve,  has  experimentally  treated  a 
nerve.  He  may,  for  instance,  apply  a caustic  and  elicit  a sensation  of  pain, 
and  state  that  he  has  stimulated  the  nerve.  He  may,  for  instance  again,  ap- 
ply an  electric  current,  stimulate  the  nerve,  and  cause  miiscular  contractions. 
Or,  finally,  he  may  by  pressure  or  tapping  upon  the  nerve,  cari’ied  to  the 
point  of  exhaustion,  secure  the  result  of  paralysis,  that  is,  inhibition  of  the 
nerve  action,  resulting  in  the  loss  of  sense,  or  of  motion,  or  of  both.  He 
then  says  that  he  has  desensitized  the  neive.  He  thus  by  the  use  of  physical 
agencies  produces  results  similar  to  the  normal,  for  instance,  the  contraction 
of  muscle,  and  he  reasons  that  the  imiiressions  aroused  by  such  agencies  are 
similar  to  normal;  he  has  really  stimulated,  or  inhibited,  or  desensitized. 
For  instance,  he  by  some  agency,  the  use  of  an  electric  current,  so  stimu- 
lates the  periphery  of  the  sciatic  nerve  that  he  gets  a vaso-motor  effect  in 
tlie  nerve.  He  reasons  that,  as  he  has  stimulated  the  nerve  fibers  in  a man- 
ner similar  to  normal,  therefore  there  are  symxiathetic  "^aso-motor  fibers  in 
the  sciatic  nerve.  This  was  the  actual  method  emi^loyed  in  determining  that 


32 


vaso  motor  fibers  were  contained  in  tlie  sciatic  nerve,  and  this  was  accepted 
by  the  authorities.  I believe  that  I have  thus  correctly  rej)resented  the 
views  of  the  physiologists  in  the  definition  of  these  terms. 

Second:  How  does  the  Osteopath  define  these  terms?  "WTiat  does  he 

mean  when  he  uses  them?  He  uses  them,  of  course,  in  the  normal, 
physiological  sense,  which  we  will  leave  aside.  He  also  uses  them  in  an- 
other sense,  which  for  the  present  we  will  leave  aside  also.  But  the  question 
to-day  is,  does  he  by  a physical  agency,  that  is,  by  manixjulation,  by  pres- 
sure, by  tapi)ing,  and  stretching,  all  of  which  he  uses  in  effecting  nerve  fila- 
ments or  nerve  centers,  produce  a result  similar  to  normal,  and  he  be,  with 
the  j)hysiologist,  allowed  to  reason  that  therefore  the  impulse  which  he  has 
aroused  by  the  use  of  such  i^hysical  agencies  is  similar  to  the  normal?  A 
pressure  on  the  phrenic  nerve  controls  the  spasm  of  hiccoughs.  The  result  of 
the  use  of  such  physical  agency  is  similar  to  normal,  hence  the  impulse  must 
have  been  similar  to  normal.  Again,  by  rubbing  the  neck  in  the  region  of 
the  superior  cervical  ganglion,  he  stops  bleeding  from  the  nose,  and  j)roduces 
an  effect  similar  to  normal,  hence  the  vaso  motor  influence  generated  by  ir- 
ritation in  that  region  must  be  similar  to  normal.  He  says  he  desensitized 
phrenic  or  stimulated  the  superior  cervical  ganglion.  We  must  allow  him 
equally  with  the  physiologist  to  say  that  he  has  stimulated,  or  inhibited,  or 
desensitized  the  nerve  in  question.  Aow,  the  question  at  once  arises,  what 
was  the  manner  of  the  application  of  those  physical  agencies?  Does  the 
physiologist,  as  well  as  the  Osteopath  apply  these  agencies  externally?  Of 
course  if  there  is  a difference  in  application,  then  our  reasoning  would  not 
hold  good.  But  my  reply  here  is,  yes,  he  applies  them  externally,  though 
not  always.  Still,  if  he,  the  physiologist,  does  it  only  sometimes,  and  ob- 
tains results  which  justify  him  in  saying  that  he  has  really  desensitized,  stim- 
ulated or  inhibited,  the  case  is  proven  for  the  Osteopath,  even  though  the 
latter  works  externally  always,  providing  only  that  the  Osteopath  obtains  as 
wide  a range  of  results  as  does  the  physiologist,  who  works  both  externally 
and  upon  the  exposed  nerve  or  center.  That  the  Osteopath,  by  his  means 
obtains  results  in  every  part  of  the  body  is  shown  by  cases  upon  record. 

I wish  to  quote  from  text  books  to  show  that  the  physiologist  does  work 
externally  upon  the  body  to  produce  his  results.  In  the  first  place  I quote 
from  Dr.  Lombard,  Professor  of  Physiology  in  the  University  of  Michigan, 
in  Howell’s  American  Text  Book.  “If  i^ressure  be  brought  to  bear  uj)on  the 
ulnar  nerve  where  it  comes  across  the  elbow,  the  region  supplied  by  the 
nerve  becomes  numb.”  Aow,  in  the  context  he  explains  that  everyone  has 
occasion  to  demonstrate  this  upon  himself,  evidently  imjDlying  that  external 
I^ressure  was  used.  Dr.  AY.  T.  Porter,  M.  D.,  Assistant  Professor  of 
Physiology  in  Harvard  .Medical  School,  in  the  same  text  book  states  as  fol- 
lows: “The  reflex  action  of  the  sympathetic  nerve  upon  the  heart  is  well 


shown  by  the  experiment  of  F.  Goltz  in  a medium  sized  frog,  the  percardium 
was  exposed  by  carefully  cutting  a small  window  in  the  chest  wall.  The 
pulsations  of  the  heart  could  be  seen  through  the  thin  pericardial  membrane. 
Goltz  now  began  to  ta})  upon  the  abdomen  at  the  rate  of  about  140  times  a 
minute  with  the  handle  of  a scalpel.  The  heart  gradually  slowed  and  at 
length  stood  still  in  diastole.  Goltz  now  ceased  the  rain  of  little  blows.  The 
heart  remained  quiet  for  a time,  and  then  began  to  beat  again,  at  first  slowly 
and  then  more  rapidly.  Some  time  after  the  experiment,  the  heart  beat  about 
five  strokes  in  the  minute  faster  than  before  the  experiment  was  begun.  The 
effect  cannot  be  obtained  after  section  of  the  vagi.” 

I have  thus  quoted  at  length  to  show  with  exactness  the  manner  of  ex- 
l)erimentation  and  the  external  application  of  this  physical  agency  which  was 
employed.  Again,  the  physician  in  applying  the  electric  current  to  a living 
patient  for  the  purpose  of  diagnosis  or  treatment,  applies  the  same  externally. 
I quote  from  Dana:  “Statical  electricity  is  applied  from  fifteen  to  twenty- 

minutes  daily  or  tri  weekly.  For  general  tonic  or  sedative  effects,  sparks  are 
drawn  from  all  parts  of  the  body  except  the  face;  in  paralysis  or  spasms  of 
pain,  sparks  are  applied  to  the  effected  ai’ea.  In  general  electrization, 
whether  galvanic  oi'  faradic,  the  indifferent  electrode  is  placed  on  the  sternum, 
feet  or  back,  and  the  other  pole  is  carried  over  the  limbs,  trunk,  neck,  and, 
if  indicated,  the  head.”  In  this  course  of  the  argument  I wish  to  instance 
what  I heard  Dr.  Eckley  say  once  concerning  the  surgical  method  of  treat- 
ing sciatica.  He  said  that  an  incision  was  made  through  the  gluteal  mus- 
cles down  to  the  nerve,  laying  it  oi^en  to  view;  that  a hook  was  then  used, 
and  the  nerve  stretched  with  a force  of  about  forty  pounds,  that  is,  sufficient 
to  I'aise  the  heel  of  the  patient  from  the  table,  the  patient  hfing  on  his  face. 
That  was  the  surgical  method  of  stretching  the  nei’ve  to  relieve  cases  of 
sciatica.  He  also  went  on  to  say  that  the  method  used  nowadays  is  that  of 
ttexing  the  thigh  ujion  the  thorax,  thus  giving  a strong  tension  to  the  nerve, 
and  that  is  the  treatment  used  to-day  by  physicians  for  the  cure  of  sciatica. 
You  will  see  that  that  was  external  manipulation,  that  the  apjilication  of  the 
electrical  curient  was  external,  the  tapping  iipon  the  abdomen  was  external, 
and  the  pressure  upon  the  ulnar  nerve  was  external.  I have  simply  en- 
deavoi'ed  to  show  that  the  Osteopath  in  treating  nerves  and  centers  employs 
physical  agencies  externally.  In  one  case  the  physiologist  is  allowed  to  say. 
and  it  is  accepted  by  the  authorities,  that  he  has  stimulated  a nerve,  stimu- 
lated nerve  action  by  this  means,  and  inhibited  nerve  action  by  this  means, 
and  my  argument  is,  therefore,  that  in  the  same  manner  the  Osteopath  must 
be  allowed  to  say  that  he  has  stimulated  or  inhibited  nerve  force,  and  that 
we  therefore  use  these  terms  in  the  generally  accepted  manner.  This  is  my 
view  of  the  subject,  and  T believe  that  my  conclusions  are  reasonable  and 
fair.  That  from  the  results  accomplished,  means  employed,  and  manner  of 


34 


application  of  the  physical  agency  by  the  physiologist  and  by  the  Osteopath, 
the  latter  is  as  much  entitled  as  is  the  former  to  ths  use  of  the  terms  stimula- 
tion, and  inhibition  in  their  generally  accepted  sense. 

I shall  follow  this  subject  further  for  a lecture  or  two.  There  are  many 
points  in  relation  to  the  work  upon  nerve  centers  which  are  obscure,  and 
which  I think  I can  with  value  attempt  to  illustrate  before  you. 

II.  How  TO  Treat  a Spine.  (Continued.) — Whereas,  the  last  time  I 
gave  you  the  treatment  for  the  spine  itself,  to-day  I will  take  up  the  con- 
sideration of  treatment  of  the  spine  for  distant  effects.  The  point  here  is, 
that  we  may  not  only  treat  the  spine,  with  the  patient  upon  his  face,  for  im- 
mediate effects  to  the  spine,  but  we  may  treat  to  reach  viscera  through  the 
sympathetic  nervous  system.  Your  first  object  is  to  relax  all  the  structures 
as  in  the  other  case,  for  the  reason  that  tension  here  in  the  mnscles  may  af- 
fect a center,  it  may  affect  not  only  the  center  which  relates  to  the  spine  it- 
self, but  a center,  for  instance,  the  splachnics,  controlling  the  stomach,  or 
the  kidneys,  or  the  bladder,  or  some  of  the  internal  viscera.  You  will  very 
commonly  find  sore  spots  along  the  spine.  The  indication  is  usually  that 
they  are  the  seat  of  lesions.  We  reason,  then,  according  to  the  sore  spots, 
or  according  to  the  contraction  of  the  muscles,  or  according  to  the  separation 
of  the  vertebrre,  or  whatever  the  lesion  may  be,  to  the  centers  of  the  sym- 
pathetic affected.  If  we  know  where  the  different  centers  are  situated  along 
the  spine,  and  find  a lesion  at  a certain  point,  we  can  reason  what  the  result 
would  be,  or  vice  versa,  by  finding  a certain  disease  manifest  in  the  body  we 
can  trace  back  from  the  disease  to  the  center,  and  expect  to  find  a lesion  at 
or  near  that  center.  For  instance,  suppose  I had  examined  this  gentleman 
and  found  that  he  had  lung  trouble,  I would  then,  according  to  Osteopathic 
procedure,  go  back  to  the  centers  along  the  spine,  and  I would  look  from  the 
second  to  the  seventh  dorsal  for  a lesion,  and  if  I did  not  find  a lesion,  I 
would  still  stimulate  in  that  region.  I might  here  instance  a case  that  I have 
treated,  a case  of  congestion  of  the  lungs  associated  with  heart  trouble,  where 
there  was  great  difficulty  of  breathing,  considerable  jiain  accompanied  by 
liallor  and  general  debilitj',  and  there  was  every  indication  that  the  lungs 
were  affected.  And  by  giving  not  more  than  a minute’s  work  in  this  region, 
from  the  second  to  the  seventh  dorsal  on  both  sides;  the  patient  sitting  ujion 
a stool,  I,  standing  behind,  raising  the  ribs  and  stimulating  the  centers,  got  a 
good  effect.  Sometimes  in  such  a case  you  have  to  work  cpiickly,  and  in 
some  cases  you  will  find  that  it  will  not  do  to  have  the  patient  lie  dovni.  If 
I should,  for  instance,  be  treating  this  gentleman  for  stomach  trouble,  hav- 
ing in  my  examination  and  in  my  conversation  with  him  found  that  he  was 
so  afflicted,  I would  look  for  some  lesion  along  the  spine  in  the  region  of  the 
splachnics,  from  the  sixth  dorsal  down  to  the  twelfth,  especially  the  upper 
splachnics  for  the  stomach,  And  in  that  event,  how  would  1 go  about  to 


ti'eat  him'?  Simply  l)y  use  of  tlie  points  which  I gave  you  in  how  to  treat  the 
spine.  I would  loosen  the  spine,  and  relieve  any  tension  in  the  ligaments 
which  I might  find  there.  I would  stimulate  the  muscles  all  along  in  this 
region,  and  woj'k  out  any  sore  spots,  and  any  contracted  muscles.  This  con- 
tracture, or  tightening  of  the  muscles,  I shall  go  into  deeper  in  the  course  of 
a lecture  or  two.  Thoroughly  work  along  the  spine,  not  too  hard,  using  the 
flat  of  the  fingers,  which  requires  some  little  strength  in  the  muscles  of  the 
forearm.  You  need  not  he  afraid  of  the  patient,  you  need  not  be  afraid  to 
apply  your  treatment  thoroughly,  but  you  should  use  your  judgment  as  to 
how  long  a treatment  you  should  give.  It  is  very  hard  to  say  anything  as  to 
the  length  of  time  of  treatment;  you  will  have  to  learn  that  for  yourselves. 
Though  in  general  a young  Osteopath  will  treat  a very  long  time,  and  an  old 
operator  will  treat  a much  shorter  time.  If  I should  find  that  there  was 
genital  trouble  or  trouble  with  the  pelvic  viscera  I shoidd  natui-ally  look 
along  the  centers  in  the  lumbo-sacral  region,  and  I would  very  likely  find  a 
lesion  at  the  tifth  lumbar,  where  I woidd  find  a soreness.  In  that  case  he 
would  relax  all  the  parts;  I would  bring  the  legs  up  against  me  and  get  a 
close  application  of  the  hand  to  the  affected  spot.  Then  holding  in  the  sacro- 
iliac articulation,  and,  by  lifting  up  against  it  allowing  the  weight  to  hang 
down  from  that  i^oint,  I spring  the  pelvis  and  bring  pressui’e  upon  these  liga- 
ments, first  on  one  side  and  then  on  the  other,  relaxing  all  the  structures 
around  the  fifth  lumbar,  preparatory  to  reducing  any  slip  which  may  be 
found  there.  Suppose  there  was  not  a slip  there  but  simply  a sore  spot,  my 
object  would  be  then  to  work  out  the  sore  spot  and  thoroughly  relax  all  of 
the  tension.  I will  take  the  setting  of  the  slip  of  the  siiine  at  another 
time.  In  the  examination  of  a spine  we  may  find  a vertebra?  lateral  at  any 
point.  Suppose,  for  instance,  that  the  twelfth  dorsal  is  slipped  laterally,  to- 
ward the  light,  we  would  very  probably  find  that  the  sore  spot  was  on  the 
right  side,  as  the  sore  spots  in  the  muscles  are  as  a rule  on  the  side  to  which 
the  spine  is  slipped,  though  it  may  be  on  the  other  side.  I would  fir.st  treat 
here  at  the  twelfth  dorsal,  loosening  the  muscles  about  that  point.  How  do  I 
know  when  I have  done  enough  of  that?  In  general,  when  you  find  a more 
relaxed  condition  there.  Yet  you  cannot  always  at  the  first  treatment  relax 
all  the  muscles;  you  will  hnd  cases  very  stubborn.  I have  treated  cases 
where  the  muscles  would  relax  under  treatment  but  would  contract  again  im- 
mediately. It  will  depend  upon  the  case,  but  work  a reasonable  length  of 
time  and  relax  all  the  parts  if  possible.  After  I have  relaxed  all  the  muscles 
upon  the  right  side  about  the  twelfth  dorsal,  I pursue  the  same  course  on  the 
left  side;  then  go  deeper  than  the  muscles  and  stretch  the  ligaments.  YTiat 
is  the  condition  of  those  ligaments  when  the  spine  is  slipped  in  this  way?  I 
have  shown  you  in  a previous  lecture  that  they  are  probably  all  upon  a ten- 
sion, some  forward  and  some  backward.  'SYhat  we  seek  to  do  is  to  spring 


36 


the  spiue  up.  By  springing  it  you  get  the  curve  above  and  thus  stretch  the 
ligaments  on  this  side;  then  turn  the  patient  over  and  go  through  the  same 
process  upon  the  other  side,  ^^ow,  you  will  naturally  want  to  know  how 
soon  to  attempt  to  reduce  this  slip  of  the  vertebra.  Most  young  Osteopaths 
when  they  find  a dislocation  want  to  put  it  back  into  place  at  once.  You  can 
only  do  that  in  rare  cases.  In  a recent  dislocation,  if  it  is  not  very  serious 
and  does  not  set  up  a great  amount  of  inflammation,  it  may  be  reduced  at 
once.  In  an  old  dislocation  you  will  have  to  work  a considerable  time  to  re- 
lax all  these  parts,  throw  new  blood  and  nerve  force  there  to  endow  them 
with  new  vitality  which  they  have  been  lacking,  and  you  will  have  to  learn 
by  practice  to  work  a sufficient  leng-th  of  time  before  attempting  to  set  a 
vertebra.  There  are  several  methods  of  doing  this.  One  of  the  best  is  to 
first  exaggerate  the  condition.  I would  in  this  case  have  my  patient  upon  a 
stool,  the  spine  being  tipped  over  toward  the  right,  I bend  the  patient  so  as 
to  exaggerate  the  condition,  and  thus  bring  tension  upon  the  ligaments  upon 
that  side.  I have  before  brought  tension  upon  the  other  side  and  relaxed 
everything  as  far  as  possible,  and  by  working  the  patient  up  and  around, 
holding  against  the  sj)ine  of  the  vertebra,  I in  that  way  slip  it  back  into 
place.  It  does  not  always  go  back  with  a pop  as  nicely  as  could  be,  but  you 
will  perhaps  have  to  pursue  that  method  of  treatment  for  a considerable 
length  of  time.  But  remember, please,  that  in  setting  a misplaced  vertebra, 
in  general  the  method  is  to  exaggerate  the  condition,  and  that  you  then  work 
in  just  the  opposite  way  and  throw  the  curve  in  the  opposite  direction. 

Q.  I do  not  understand  the  connection  of  the  5tb  nerve  with  the  pneu- 
mogastrie. 

A.  The  pneumogastric  supplying  the  stomach  is  affected  directly  from 
an  exciting  cause,  the  impulse  passes  along  the  pneumogastric  going  directly 
to  the  medulla,  which  is  the  center  for  all  of  these  nerves  which  arise  from  the 
floor  of  the  fourth  ventrical,  and  then  directly  out  over  the  5th  cranial  nerve. 
It  has  been  proved  that  an  impulse  can  be  sent  from  a nerve,  through  a center, 
and  out  over  another  nerve. 

Q.  In  referring  to  the  back  work  we  have  gone  over,  I do  not  quite  un- 
derstand why  a click  in  the  neck  in  the  cervical  region  should  be  more  serious 
than  in  the  rest  of  the  spine. 

A.  Well,  I so  stated  simply  because  it  has  been  my  experience  that  I 
could  find  these  noises  all  along  the  spine  when  they  mean  nothing  at  all,  the 
subject  being  perfectly  healthy.  While  in  the  cervical  region  it  seemed  to  me 
that  there  was  alwa3"S  some  slight  lireak  or  contraction  between  the  parts,  like- 
ly enough  to  be  serious.  It  showed  that  the  blood  supply  had  been  cut  off. 
thus  diminishing  the  supply’  of  lubricating  material  in  the  synovial  membrane 
I said  that  it  was  in  general  more  serious,  because  my  experience  in  practice 
seemed  to  bear  out  that  point. 


Q.  In  the  case  of  a lateral  displacement  of  the  atlas,  would  you  exaggerate 
the  condition  also? 

A.  Yes,  sir,  as  far  as  possiole,  but  to  set  an  atlas  is  quite  a technical 
matter.  I will  take  that  in  detail  later. 

Q.  Suppose  there  was  a spinal  curvature  would  you  set  it  in  the  same 
way  you  would  a single  vertebra? 

A.  In  that  case  you  would  use  the  same  general  method,  but  you  would 
begin  at  one  definite  point  and  try  to  set  it,  and  then  work  upon  the  next  ver- 
tebra, and  so  on. 

LECTURE  VIII. 


At  the  last  lecture  I commenced  to  consider  the  osteopathic  theory  of  work 
upon  nerve  centers.  That  is  what  I have  called  the  subject  in  general,  al- 
though it  includes  not  only  nerve  centers,  but  nerve  distribution  and  blood 
supply ; how  the  osteopath  works  by  external  manipulation  upon  the  surface  of 
the  body,  gaining  results  internally.  I first  defined  the  terms  stimulation  and 
inhibition,  and  showed  that  while  they  are  used  in  several  senses,  the  osteo- 
path uses  them  in  the  usual  sense.  Our  conclusion  was  that  the  osteopath  was 
justly  entitled  to  the  use  of  these  terras,  stimulate  and  inhibit  nerve  action,  and 
that  he  works  in  the  same  manner  as  the  physiologist  when  he  is  experimenting 
upon  these  nerves.  That  since  the  physiologist,  gaining  results  which  were 
similar  to  normal,  reasons  that  he  has  therefore  affected  the  nerves  in  a man- 
ner similar  to  normal,  the  osteopath  should  be  allowed  to  say  that,  since  he  has 
gained  results  similar  to  normal,  he  has  also  affected  the  nerves  in  a normal 
manner.  As  to  the  term  “desensitize”,  I was  not  fully  informed.  I have 
since  found  that  there  is  no  such  word,  it  is  not  in  the  Century  Dictionary,  and 
I think  I had  better  dispense  with  the  use  of  it.  However,  we  do  the  thing, 
whether  we  have  the  word  the  same  or  not.  That  is,  taking  away  the  sensi- 
tiveness from  a nerve,  or  the  excitability,  or  its  excited  condition,  is  really  an 
inhioition  of  nerve  force.  Or  it  may  amount  to  this,  that  we  affect  the  con- 
ductivity of  the  nerve,  and  that  is  what- 1 meant  bj'  the  use  of  the  word  desens- 
itise. Since  it  was  simply  the  improper  use  of  the  word,  and  not  any  confus- 
■ ion  of  points,  I do  not  think  we  have  to  yield  any  point  to  the  authorities 
there.  We  then  are  privileged  to  say  that  by  external  manipulation  we  have 
really  stimulated  or  inhibited  a nerve.  If  we  have  worked  upon  nerves  and 
upon  nerve  centers  in  that  way,  we  have  produced  certain  results.  The  point 
that  the  physiologist  works  externally  only  sometimes,  while  we  work  outside 
altogether,  does  not  make  any  difference  with  argument,  from  the  fact  that  we 
have  as  broad  a range  of  results  to  show  for  our  work  as  he  has  by  both  ex- 
ternal work  and  work  upon  the  exposed  nerve.  I think  that  my  position  taken 
at  that  time  was  sound. 


38 


1.  Theory  of  Osteopathic  \Voek:  upoy  Centers.  (Continued.) — 
Our  operators  agree  that  we  secure  direct  results  upon  nerves  by  mechanical 
work,  and  while  they  do  not  all  fully  agree  in  all  they  say,  I gather  from  the 
coinmunicatious  they  have  handed  me  that  they  all  take  that  view  of  the  matter. 
For  instance.  Dr.  McConnell  says  ; “We  affect  internal  nerve  action  by  man- 
ipulation on  the  external  parts  of  the  body,  by  a general  mechanical  stimula- 
tion given  to  the  nervous  system-’’  He  says  further,  that  we  stimulate  or  in- 
hibit sometimes  but  that  he  believes  there  is  a general  misuse  of  these  terms, 
and  that  the  results  which  may  be  expressed  in  these  terms,  are  not  often  the 
result  of  some  direct  inhibiting  or  some  direct  stimulating  work  that  we  pul 
upon  an  affected  point.  But  we  will  bring  that  point  up  when  I come  to  take 
up  the  further  definition  of  these  terms  according  to  the  osteopathic  point  of 
view.  Dr.  Harry  Still  says,  “We  inhibit  by  pressure  or  by  holding,  thus  cut 
off  nerve  action  , and  break  the  force  between  the  termination  of  the  nerve.’’ 
Dr.  Harry  also  says  that  work  outside  upon  the  body,  that  is  mechanical  man- 
ipulation, produces  a direct  effect  upon  the  nerves  through  pressure,  thus  af- 
fecting sympathetic  life  through  its  connection  with  the  spinal  nerves  or  their 
centers.  He  instanced  the  pneumogastric.  Mrs.  Still’s  reply  shows  that  her 
idea  is  that  we  either  directly  or  reflexly  affect  nerves  or  centers  by  external 
manipulation.  Dr.  C.  M.  T.  Hiilett  well  illustrates  the  theory  of  our  work  as 
follows;  “Pressure  upon  a nerve  fibre  will  cause  a break  in  the  continuity  of 
the  semi-fluid  axis  cylinder ; and  if  abnormality  exists,  then  the  everpresent 
tendency  toward  the  normal  will  tend  to  restore  normal  conditions.’’  I under- 
stand him  to  say  that  we  may  obtain  that  result  by  pressure  upon  a nerve,  by 
external  manipulation,  which  is  the  method  we  employ.  Dr.  Hildreth  and  Dr. 
Charles  Still  both  have  something  to  say  about  this.  I could  not  get  their 
communications  to-da}",  but  will  bring  them  later.  Thus,  as  you  see,  there  is 
considerable  unanimity  upon  this  point.  I have  not  quoted  all  these  parties 
have  to  say,  but  I shall  quote  from  them  to  explain  further  points  when  we 
come  to  them. 

Remember,  that  this  is  not  the  only  effect  that  we  get  upon  nerve  centers 
or  nerve  life,  this  mere  stimulation  or  inhibition,  as  we  may  be  privileged  to 
call  it,  but  that  we  do  it  and  get  important  results.  I leave  this  subject  to 
consider  a different  point — there  are  other  means  at  the  osteopath’s  command, 
by  which  he  may  affect  blood  and  nerve  force.  These  means  are  important, 
but  they  are  not  what  we  style  as  the  most  important  means  at  our  command. 
They  are,  however,  important  as  being  external,  non-medicinal  methods  of 
reaching  deep  blood  and  nerve  force.  They  are  not  distinctively  Osteopathic; 
they  are  simply  adjuncts  to  our  work.  One  of  these  is  the  external  application 
of  heat  or  cold.  I shall  take  up  later,  possibly,  the  subject  of  Hydrotherapeut- 
ics and  kindred  subjects.  Green  in  his  Pathology  says,  “It  seems  that  vascu- 
lar dilatation  of  deep  organs  may  be  produced  reflexly  by  the  application  of 


39 


stupes  to  the  skiu,”  They  are  valuable,  then,  as  adjunets  which  the  osteopath 
may  call  to  his  aid  if  necessary.  I may  instance  here  that  in  case  of  inflamma- 
tion following  some  injury,  you  may  find  the  parts  so  swollen  as  to  make  it  im- 
possible for  you  to  determine  whether  or  not  parts  are  broken,  or  what  the 
condition  really  is.  You  will  frecpiently  find  that  m such  cases  you  must  first 
reduce  the  swelling  before  you  can  apply  your  osteopathic  work.  Xot  to  say 
that  we  do  not  do  it  osteopathieally,  for  I believe  that  we  do.  In  the  case  of  a 
swollen  ankle  we  may  by  manipulation  of  the  venous  flow,  loosening  the  struc- 
tures about  the  femoral  vein,  aid  in  taking  down  the  swelling,  but  you  will 
find  that  if  such  cases  be  of  any  great  extent,  you  must  bring  in  the  application 
of  heat  or  cold. 

You  will  have  to  use  fomentations  and  the  application  of  dry  heat  very  of- 
ten, and  it  is  always  advisable  to  have  a good  supply  of  hot  water  near  you  in 
case  you  have  a patient  where  it  is  likely  to  be  necessary.  For  instance,  if 
you  are  treating  a patient  for  some  disorder,  and  he  is  continually  troubled 
with  cold  feet  while  lying  m bed,  you  must  use  the  application  of  heat,  the 
idea  being  to  get  the  patient  as  comfortable  as  possible,  and  to  get  a good  dis- 
tribution of  blood  throughout  the  system  ; also  to  prevent  collateral  hyperemia 
on  account  of  having  too  little  blood  in  one  part.  I think  this  is  a good  thera- 
peutic hint  for  the  osteopath,  iou  must  pay  attention  to  these  details,  or  some 
such  little  thing  may  hinder  to  a considerable  extent,  the  results  you  are  try- 
ing to  attain.  The  idea  is  to  equalize  the  flow  of  blood  throughout  the  body. 
The  application  of  cold  is  frequently  useful,  though  we  do  not  use  it  very 
often.  I spoke  of  fomentations,  that  is  a term  applied  to  a hot,  moist  applica- 
tion. You  will  frequently  find  it  useful  to  wring  out  a cloth  in  hot  water,  as 
hot  as  can  be  borne,  and  appl}^  it  to  parts,  repeating  the  operation  frequently. 
That  is  a fomentation,  while  dry  heat  is  applied  b}'  means  of  a hot  water  bag, 
or  some  such  thing.  Please  bear  in  miud  that  these  things  are  good  in  our 
practice.  You  may  also  get  a vaso  motor  effect  by  application  of  cold.  Speak- 
ing of  renal  constriction,  Howell’s  Text  Book  says:  “The  same  effect  (renal 

constriction)  is  easily  produced  by  stimulating  the  skin,  for  example,  by  ap- 
plication of  cold.’’  Remember,  please  that  we  as  osteopaths  do  not  depend  upon 
the  use  of  these  agents,  but  I call  your  attention  to  them  as  valuable,  nou- 
medicinal  adjuncts  to  our  practice,  and  also  as  supporting,  by  quotations  from 
standard  text  books,  the  contention  of  the  osteopath,  that  without'  medication 
the  blood  and  nerve  forces  of  life  may  be  regulated  to  produce  health.  This  is. 
too,  valuable  in  our  arguments  wdth  medical  men.  It  all  tends  against  the  use 
of  medication.  I believe  that  the  osteopathic  position  may  be  .still  further 
strengthened  by  considering  the  effects  produced,  on  the  one  hand  by  the  use 
of  chemicals,  drugs,  or  electric  currents,  and  on  the  other  hand  by  the  osteo- 
path in  his  use  of  mechanical  agents.  In  the  first  place,  drugs  and  chemicals 
introduced  into  the  system  alter  normal  chemical  conditions  in  which  the  nerve 


40 


must  be  in  ordei’ that  its  normal  irritability  may  be  preserved.  In  Howell’s 
Text  Book  it  is  stated  that  the  introduction  of  digitalis,  ether,  alcohol,  vrater, 
etc.,  changes  the  condition  of  the  irritability  of  the  nerves.  “From  all  these 
results  it  becomes  evident  that  the  normal  irritability  of  nerves  and  muscles  re- 
quire that  a certain  chemical  constitution  be  maintained,  and  that  even  a slight 
variation  from  this  suffices  to  alter,  and  if  continued,  to  destroy  the  irritability. 
Now,  it  is  the  physician,  and  not  the  osteopath,  who  introduces  these  abnormal 
chemical  conditions,  thus  destroying  the  normal  irritability.  I grant  the  force 
of  the  physicians’  argument  when  he  says  that  he  supplies  these  drugs  for  the 
purpose  of  supplying  to  the  body  some  elements  which  are  lacking,  but  I doubt 
whether  that  is  the  general  method  of  medication.  Where  digitalis  is  given  to 
retard  the  action  of  the  heart  it  paralyzes  the  nerves  and  in  that  case  certainly 
it  was  not  given  to  supply  the  lack  of  some  such  constituent  in  the  system. 
On  the  other  hand,  the  osteopath  does  not  introduce  any  of  these  foreign  sub- 
stances. He  stimulates  nature,  and  nature  supplies  from  the  food  these  vari- 
ous things  which  are  needed  to  keep  the  normal  chemical  conditions  under 
which  a nerve  or  muscle  is  normally  irritated.  I further  quote  from  Howell’s 
Text  Book  to  show  the  abnormal  effects  of  electricity.  “Undoubtedly,  chem- 
ical and  physical  alterations  may  occur  in  nerves  as  the  result  of  the  passage  of 
an  electric  current  through  them,  and  it  would  seem  that  the  loss  of  conductiv- 
ity which  they  show  when  subjected  to  strong  currents  is  to  be  accounted  for 
by  such  means.”  “The  conductivity,  like  the  irritability  of  nerve  and  muscle 
is  greatly  inflneuced  by  anything  which  alters  chemical  constitution  of  active 
substance.”  Hence  it  must  be  that  electilcity,  chemicals  and  drugs  produce 
abnormal  changes  in  nerve  tissues.  Therefore,  I maintain  that  the  osteopath 
may  secure  better  results  from  his  manipulation  than  may  the  physician,  for, 
whereas  the  latter  introduces  into  the  system  those  agents  which  by  their  nature 
produce  abnormal  changes  in  nerve  tissue,  the  osteopath  introduces  no  foreign 
matter.  Moreover,  he  may,  through  his  manipulation,  attain  results  very  simi- 
lar to  that  produced  by  normal  physical  exercise  of  parts  oE  the  body.  I might 
explain  here  the  effect  upon  the  nerves  of  an  athlete  in  stooping  and  jumping. 
He  may,  for  instance,  stoop  in  such  a way  as  that  the  thorax  is  bent  upon  the 
thighs,  the  knees  touching  the  shoulders,  and  the  sciatic  nerve  is  stretched,  just 
as  we  stretch  it  in  sciatica.  There  are  normal  exercises,  the  results  of  which, 
if  we  can  judge  at  all,  are  exactly  similar  to  results  we  obtain  by  giving  a cer- 
tain motion  which  is  in  our  stock  of  remedies,  we  might  say.  Thus  we  reason 
concerning  various  contractions  of  muscles,  motions  of  the  back,  bringing 
elastic  pressure  upon  the  parts  and  thus  keeping  them  stimulated  up  to  the 
normal.  I think  that  the  similarity  is  readily  seen  between  normal  exercise,  on 
the  one  hand,  and  the  application  of  osteopathic  methods  on  the  other:  between 
the  application  of  violent  means  such  as  the  use  of  electric  currents,  chemicals 
and  drugs,  and  the  application  of  normal  exercise  to  the  parts  by  osteopathic 


41 


manipulatiou.  In  the  treatment  of  disease,  normal  exercise  differs  from  osteo- 
pathic treatment,  in  that  the  osteopath  has  the  patient  passive  in  his  hands  and 
can  work  at  will.  These  are  not  exercises  upon  his  part,  and  it  may  be  that  he 
being  ill  would  not  be  able  to  undergo  such  exercises  of  his  own  free  will. 

Remember,  please,  that  the  points  which  I have  brought  out  have  been  ad- 
duced in  favor  of  the  argument  that  we  may  work  externally  upon  the  body, 
and  thus  stimulate  or  inhibit  nerve  force.  But  we  do  not  consider  that  the 
most  important  part  of  our  work.  What  we  consider  more  important  than  that 
I shall  take  up  when  I come  to  describe  what  the  osteopath  means  in  the  second 
sense  in  which  he  defines  these  terms,  and  this  is  but  one  part  of  the  argument. 
I shall  at  the  next  lecture  attempt  to, carry  this  line  of  thought  a little  further 
by  quoting  from  authorities  in  support  of  the  view  that  we  may  stimulate  or  in- 
hibit nerve  force  by  external  work. 

II.  How  TO  Treat  the  Spine. — (Continued.) — I showed  you  at  the  last 
lecture  how  to  treat  a spine  where  a vertebra  was  displaced  laterally.  To-day  I 
want  to  show  you  how  to  proceed  when  you  find  the  spines  separated.  If  by 
examination  we  find  that  there  is  a separation  between  the  twelfth  dorsal  and 
first  lumbar,  how  should  we  go  about  to  rectify  the  conditions?  How  should  I 
heal  the  breach?  In  such  a case  of  course  our  method  of  reasoning  is  that 
there  is  a lack  of  tone  here ; there  is  a relaxation  of  the  ligaments ; we  would 
rather  expect  that,  though  it  is  not  necessarily  so.  And  in  that  case,  we  would 
first  go  about  to  restore  tone  to  all  the  parts  here  before  proceeding  further.  I 
need  not  go  over  the  same  ground  of  explaining  to  you  that  you  thus  here 
reach  the  central  distribution  of  the  sympathetics  all  about  this  part  which  is 
lacking  in  tone,  but  in  this  case  that  would  be  the  first  step,  and  you  might  al- 
most say  the  only  step,  although  that  is  saying  a little  too  much.  The  proba- 
bilities are  we  would  not  be  able  to  put  these  vertebrea  back  into  place  at  once, 
you  cannot  -do  that  often.  Simply  thoroughly  stimulate  and  loosen  up  the 
structures,  and  patiently  await  results,  and  you  will  gradually  see  those  spines 
coming  together.  So  that  your  best  method,  finally,  is  to  stimulate,  first  ou  one 
side  and  then  on  the  other,  using  the  motions  I have  given  you,  bring  about  a 
strengthening  of  those  parts.  You  need  not  work  just  between  the  twelfth 
dorsal  and  first  lumbar,  work  a little  higher  and  a little  lower,  and  get  a good 
effect  all  about  the  parts.  Probably  this  motion  of  getting  the  elbows  between 
the  pelvis  and  shoulder,  and  spreading  while  you  have  the  fingers  on  the  op- 
posite side  of  the  spines,  and  springing  up  as  you  spread,  will  obtain  good  re- 
sults. 

Q.  If  the  three  upper  lumbar  and  two  lower  dorsal  vertebrae  are  posterior, 
in  that  case  would  springing  it  in  that  way  tend  to  bring  it  back  to  the  proper 
position  in  time? 

A.  Yes,  in  part.  I shall  take  that  up  when  I consider  variations  from 
normal  curves  ; that  would  be  a part  of  the  method,  however. 


42 


Probably  I would  have  the  patient  sit  up  on  a stool  in  case  they  are  separ- 
ated. You  can  separate  them  a little  more.  Going  upon  the  principle  of  ex- 
aggerating the  defect,  spread  them  a little  more,  thus  allowing  a stretch  and  a 
recoil,  which  naturally  follows,  and  in  that  way  throw  new  life  to  the  part,  and 
then  we  seek  simply  to  push  them  together.  You  can  lift  up  and  push  down 
and  get  the  parts  approximated  in  that  way. 

Q.  In  the  lecture  reference  is  made  to  paralysis  without  loss  of  sensation, 
do  we  ever  have  loss  of  motion  without  sensation! 

A.  Yes,  frequently.  You  will  find  that  in  your  practice,  loss  of  motion 
without  loss  of  sensation. 

Q.  Do  we  have  loss  of  sensation  without  loss  of  motion! 

A.  Yes,  sir,  you  may  have  either. 

Q.  Is  epilepsy  caused  by  displacement  of  the  vertebrae? 

A.  Very  frequently  caused  by  displacement  of  one  of  the  upper  cervical 
vertebrae  ; we  find  it  so  in  our  practice. 

Q.  You  were  speaking  of  stimulating  the  circulation  in  the  feet  by  the 
application  of  dry  heat,  is  there  any  practical  osteopathic  treatment  for  cold 
feet? 

A.  Yes,  but  in  case  you  have  a severe  case  of  cold  feet  it  would  be  very 
difficult  to  throw  enough  blood  to  those  feet  to  warm  them  in  case  the  patient 
were  very  sick.  You  could  not  adopt  measures  strong  enough  on  account  of 
the  general  debility  of  the  patient.  But  I will  say  this,  that  condition  yields 
gradually,  as  do  a great  many  other  things  to  treatment,  and  people  I have 
known  who  had  been  troubled  with  cold  feet  for  years  would  find,  after  a 
course  of  treatment  of  a month  or  more,  that  they  were  no  longer  troubled  in 
that  way,  that  the  general  circulation  was  better  than  it  had  been  for  years. 


LECTURE  IX. 


At  the  last  lecture  1 considered  further  the  theory  of  osteopathic  work  up- 
on centers,  and  briefl}q  to  recapitulate,  these  were  the  points  I took  up:  First, 
that  our  operators  agreed  in  the  use  of  these  terms,  stimulation  and  inhibition 
in  general,  although  there  is  some  difference  in  the  reservations  they  make. 
I also  quoted  from  different  ones  of  our  oijerators  to  show  their  opinions  in 
the  matter.  I then  called  your  attention  to  the  fact  that  that  was  notthe  only 
way,  nor  yet  the  most  important  way  in  wdiich  we  considered  these  terms; 
that  there  are  other  means  by  which  the  Osteopath  may  command  deep  nerve 
force  and  blood  flow,  by  the  application  of  heat  and  cold,  which,  while  not 
being  distinctly  Osteopathic  methods,  are  yet  at  the  Osteojiath’s  command, 
and  serve  to  strengthen  our  argument  that  these  forces  of  life  can  be  reached 
fro  - the  external  surface  by  proper  methods,  without  medication.  I quoted 


43 


from  authorities  to  substautiate  these  points.  In  general,  the  application  of 
heat  is  better  than  cold.  I compared  the  effects  produced  ui^on  the  nerves 
by  chemicals  and  by  electric  currents,  as  i^roducing  a certain  change  in  a 
nerve,  pi'oducing  a change  in  the  chemical  conditions  undei-  which  a nerve 
must  be  normally  in  order  to  be  normally  irritable,  and  so  I reasoned  that 
the  Osteopath’s  j)ractice  was  the  more  rational,  since  he  does  not  introduce 
these  foreign  things  into  the  system.  Further,  I called  your  attention  to  the 
similarity  of  the  effects  of  the  Osteopathic  work  upon  the  body,  and  the 
effects  on  the  body  of  normal  exercise;  the  difference  being,  in  part,  that  your 
patient  being  sick  is  not  able  to  undergo  these  physical  exercises,  while  in 
your  hands  he  is  jrassive,  and  these  effects  may  be  given  without  the  fatigue 
which  would  accompany  his  own  exertion.  To-day  I continue  the  considera 
tion  of  this  subject. 

I.  Theory  of  Osteopathic  AVork  Upon  Nerve  Centers. — (Con- 
tinued. ) — The  arguments  advanced  in  tlie  last  lecture  may  be  strengthened 
by  quotations  from  standard  text  books.  Having  shown  that  the  Osteopath, 
by  means  peculiai'  to  his  system  of  treatment,  accomplishes  results  through 
stimulation  and  inhibition  of  nerve  action  that  are  as  worthy  of  being  consid- 
ered normal  results  as  those  accomplished  by  physiologists  through  methods 
employed  by  them  in  experimentation;  having  shown,  further,  that  the  Osteo- 
path accomplishes  such  normal  results  in  every  part  of  the  body,  there  being 
cases  upon  record  to  prove  that  that  is  the  fact,  it  therefore  at  once  becomes 
apparent  that  the  whole  field  of  nerve-force,  controlling  directly  or  indirectly 
every  motion  or  function  of  life,  lies  open  to  the  Osteopath;  that  wherever 
there  lies  a nerve  of  the  body  capable  of  stimulation  or  inhibition,  it  is  his  to 
command,  providing  only  that  such  nerve  may  be  reached  by  Osteopathic 
methods,  either  directly,  as  through  pressure,  or  indirectly,  as  through  the 
blood  supply.  For  stimulation  is  stimulation,  and  inhibition  is  inhibition. 
It  makes  no  difference  in  fact.  I will  grant  that  there  may  be  a difference  of 
degree  of  stimulation  or  of  inhibition.  However,  having  shown  that  the  Os- 
teopath stimulates  or  inhibits  just  as  really  as  does  the  physiologist,  the  ques- 
tion of  the  degree  of  stimulation  becomes  a secondary  one,  and  one  relative 
only  to  the  point  in  view.  Eesults  obtained  in  the  cure  of  diseases  in  every 
part  of  the  body,  and  of  almost  every  known  foim  of  cureable  disease,  show 
conclusively  that  the  Osteopath  has  reallj"  stimulated  or  inhibited  nerve  force 
according  to  the  end  which  he  has  in  view.  In  would  be  uo  argument  to  say 
to  an  operator  that  he  could  not  stimulate  enough  to  cause  a man  to  jumji 
over  a table.  His  fitting  reply  would  be  that  such  was  not  the  end  in  view, 
that  the  end  in  view,  peihaps,  was  the  stimulation  of  a flagging  circulation  to 
restore  it  to  its  normal  force  and  activity,  and  that  he  very  readily  accom- 
plished that  result.  So  degree  of  stimulation  really  makes  but  little  differ- 
ence to  us,  granted  that  we  have  gained  results.  I believe  that  there  is  no 


44 


nerve  of  the  body  that  the  Osteopath  may  not  reach  by  proper  manipulation, 
either  directly  or  indirectly,  by  pressni-e,  by  correction  of  lesion,  by  removal 
of  obstruction,  or  by  control  of  blood  supply.  tVhat  that  fully  means  ve 
shall  see  as  the  subject  is  developed. 

blow,  for  further  argument,  in  view  of  the  above  facts,  it  is  interesting  to 
note  the  following  quotations  from  authorities  as  confirmations  of  the  claims 
of  the  Osteopath,  since  the  authorities  have  made  use  of  such  means  as  has 
the  Osteopath  to  produce  effects  upon  nerve  action.  Speaking  of  an  experi- 
ment upon  the  ear  of  a rabbit,  Kirk  says:  “Division  of  the  cervical  sym- 

pathetic produces  an  increased  redness  of  the  side  of  the  head,  and  looking  at 
the  ear  the  central  artery  with  its  branches  is  seen  to  dilate  and  become 
larger,  and  many  similar  branches,  not  previously  visible,  come  into  view. 
The  dilation  following  section  can  be  demonstrated  in  a very  simple  way,  by 
pressing  the  nail  of  one  finger  upon  the  nerve  where  it  lies  by  the  side  of  the 
central  artery  of  the  ear.”  So  that  you  see  that  the  application  of  the  exter- 
nal force,  in  Kirk’s  opinion,  is  equal  to  section  of  the  nerve.  Again,  from 
Green’s  Pathology;  speaking  of  the  vaso-tonic  action  of  the  sympathetics,  the 
author  says:  “The  reflex  process  is  generally  due  to  stimulation  of  sensory 

nerves,  the  dimunition  in  tonus  produced  being  more  or  less  accurately  con- 
fined to  the  region  supplied  by  the  nerve.  Friction  and  slight  irritants,  in 
the  early  stages  of  their  action,  produce  hyperemia  in  this  way.”  Thus  you 
have  another  illustration  of  the  application  of  an  external  mechanical  agent, 
that  is,  friction.  Ko  doubt  you  also  thus  set  up  a reflex  action.  I shall  con- 
sider that  further  when  I apply  this  argument  to  work  on  the  centers.  T 
quote  further  from  Howell’s  textbook,  “A  sudden  pull,  pinch,  twitch,  or  cut 
excites  a nerve  or  muscle.  All  have  experienced  the  effect  of  mechanical 
stimulation  of  a sensory  nerve  through  accidental  pressure  on  the  ulnar  ner^e 
where  it  passes  over  the  elbow.  The  crazy-bone.’  ” Speaking  of  their  irri- 
bility,  the  same  text  book  says:  “Stretching  a nerve  acts  in  a similar  way, 

for  this  is  also  a form  of  pressure,  as  Valentine  says,  the  stretching  causes 
the  outer  sheath  to  compress  the  myelin,  and  this  in  turn  to  compress  the 
axis  cylinder.”  This  is  a common  mode  of  our  treatment,  as  we  flex  the  limb 
upon  the  thorax  strongly  in  order  to  stretch  the  sciatic  nerve,  that  being  a 
part  of  the  treatment,  and  there  are  certain  movements  we  adopt  to  stretch 
the  brachial  plexus  in  nervous  affections  of  the  arm.  I quote  farther  from 
the  same  source:  “A  reflex  fall  in  blood  pressure  is  also  produced  by  a 

mechanical  stimulation  of  the  nerve  endings  in  the  muscle.”  This,  then,  was 
a mechanical  means,  and  the  fact  that  we  can  thus  work  upon  nerve  endings, 
which  of  course  occur  all  over  the  body  in  the  muscles,  gives  to  us  a fruitful 
field  for  the  application  of  ext^ernal  manipulation.  A little  further,  Howell’s 
text  book  says:  “Both  the  sympathetic  and  vagus  nerve  fibers  have  their 

influence  over  the  heart,  deceased  by  cold  and  increased  by  heat.”  Vow, 


liaving  made  these  quotations,  allow  me  to  call  your  attention  again  to  the 
fact  that  I have  quoted  thus  fully  for  the  puiqDOse  of  shovdng,  out  of  the 
mouths  of  the  authorities,  the  fact  that  the  blood  and  nerve  snpply  may  be 
regulated  by  external  manipulation,  I have  quoted  them  for  the  sake  of  the 
argiiment,  not  for  the  i)uri>ose  of  giving  license  to  oui’  practice,  because  we 
demand  license  only  ontlie  results  which  we  have  obtained.  Kor  by  the  above 
qnotations  which  I have  made  do  I intend  to  yield  a point  and  say  that  the 
Osteopath  can  obtain  only  snch  results  upon  nerve  action  as  is  attained  by 
physiologists  by  external  manipulation,  becanse  I believe  I have  shown  that 
the  conclusion  is  fair  that  the  Osteopath  can,  by  his  method,  affect  any  nerve 
in  the  body.  Hence,  I shall  deem  it  comijetent  to  give  you  vaso-motor  cen- 
ters, etc.,  with  the  understanding  that  the  Osteoxjath  has  a right  to  regard  all 
snch  as  legitimate  objects  of  treatment,  as  his  facts  to  revert  to  in  argument, 
and  as  his  eqniijment  for  work  in  the  eradication  of  disease.  As  I said,  the 
more  imijortant  x>art  of  how  the  Osteopath  stimidates  or  inhibits  is  still  to 
come,  and  I shall  i)ursue  this  subject  for  a lecture  or  two  further. 

II.  How  TO  Treat  A Spine. — (Continued.) — At  the  last  lecture  I at- 
temx>ted  to  show  you  how  we  reason  and  work  in  case  the  spines  were  separ- 
ated. In  to-day’s  lecture  I wish  to  take  uji  the  question  of  how  we  would 
work  in  case  the  sj^ines  were  aiiiiroximated.  That  is,  how  would  we  separate 
those  spines?  If,  in  passing  yonr  fingers  doAvn  the  spine  you  come  to  some 
place  where  the  spines  of  the  vertebrie  are  too  close  together,  and  this  is  a 
very  common  lesion,  your  reasoning  in  that  case  woidd  be  that  there  had  been 
some  injury,  at  that  poiut,  to  the  spine,  perhajis  a sudden  jerk  or  a twist, 
which  had  resulted  in  irritation;  that  too  much  life,  and  the  form  of  nerve 
and  blood  force,  had  been  throAvn  there,  resnlting  in  a thickening  of  these 
ligaments,  thus  contracting  and  binding  those  iiarts  together.  When  you 
come  to  study  pathology  you  will  find  that  any  irritatioa  sufficient  to  set  uj) 
an  inflammation  is  very  likely  to  be  followed  by  the  formation  of  new  connec- 
tive tissue  or  the  tickening  of  the  existing  tissues.  Thus,  you  will  find  that, 
reasoning  that  too  mucli  force  has  been  directed  to  these  parts,  onr  work  is  to 
overcome  the  results  of  such  misdirection  of  energy.  We  set  about  to  do  it 
largely  by  the  same  manipulation  as  we  would  adopt  in  the  case  of  approxi- 
mating spines,  at  least  in  the  first  stages.  We  would  loosen  np  all  the  parts, 
very  likely  you  would  find  a tension  in  the  ligaments  at  these  points  as  well 
as  in  the  mnscles.  The  muscles  show  that  they  have  been  tensed  by  the 
closeness  of  the  vertebrte.  Having  loosened  nii  all  the  mnscles,  we  would 
then  spring  the  spines  upward,  getting  this  stretching  motion  that  I have  be- 
fore described.  I would  work  with  sufficient  force,  according  to  the  size  of 
the  iiatient,  to  stimulate  these  jiarts  and  set  up  what  would  seem  to  be  a free 
action  as  far  as  possible.  You  can  then  operate  by  flexing  the  knees  up 
against  your  own  body,  and  get  considerable  purchase  on  such  a poiut  as 


46 


that,  and  while  it  is  rather  a strained  position  for  the  operator,  and  I cannot 
say  that  it  is  always  comfortable  for  the  patient,  it  is  a very  good  way  to 
work,  becanse  yon  have  your  patient  in  such  shape  that  yon  will  hardly  in- 
jure him  by  lifting  him,  as  I have  done,  fairly  off  of  the  table.  By  this 
method  yon  may  use  considerable  force,  but  of  course  you  must  not  be  rough. 
I spoke  to  you  about  a smooth  spine,  meaning  a spinal  column  which  showed 
all  along  it  that  the  spines  were  approximated  and  bound  down  close  to- 
gether. ^low,  yon  have  a variable  condition  there,  it  may  be  so  bound  to- 
gether that  it  will  be  quite  rigid,  or  it  may  be  capable  of  considerable  motion, 
but  having  this  peculiar  smooth  feeling  all  the  way,  so  as  to  lead  yon  to  sus- 
pect some  trouble.  I have  had  a number  of  cases  of  that  kfnd,  where  the 
whole  spine  was  in  that  condition,  or  some  one  particular  part  of  it,  and  al- 
most invariably  there  was  a history  of  some  strain  or  jolting  or  twisting  that 
had  set  up  an  irritation  along  the  spinal  column,  and  had  resulted  in  a tight- 
ening of  the  ligaments  which  has  resulted  in  the  approximation  of  the  verte- 
brte.  In  such  a case  the  manipulation  would  be  largely  as  I have  shown.  I 
would  simply  loosen  up  first  all  the  muscles  along  the  spiue,  remembering  to 
work  against  the  grain  of  the  muscle,  of  course  working  on  both  sides.  A 
good  way  to  do  that  by  the  motion  I gave  you  with  the  patient  on  his  face; 
you  can  exert  considerable  force,  and  as  he  is  relaxed  you  can  loosen  muscles 
very  nicely.  Having  done  that  I would  proceed  to  spring  the  spine  along  its 
various  parts.  By  flexing  the  knees  you  can  sping  the  spine  in  the  lumbar 
region,  and  by  using  the  arm  as  a lever  you  can  spring  the  spines  in  the  up- 
per region.  Of  coui-se  it  is  rather  difficult  to  spring  the  spines  between  the 
shoulders;  one  good  way  to  work  there  is  to  get  the  elbow  against  you,  and 
work  along  the  spine  by  holding  and  stretching  in  that  way,  yonr  object,  of 
course,  being  to  loosen  all  of  these  ligaments  and  to  relax  whatever  is  hold- 
ing the  spines  together. 

As  to  the  misdirection  of  energy  in  a part  resulting  in  their  being  bound 
together,  it  may  of  course  be  entirely  possible  that  at  this  present  time  there 
is  not  a misdirection  of  energy,  but  there  has  been,  whether  past  or  present 
it  does  not  make  a great  deal  of  difference.  The  misdirected  energy-  may 
have  acted  for  a time  sufficient  to  thicken  and  perhaps  to  contract  the  liga- 
ments, and  then  diffused  to  other  paids  of  the  body,  so  that  this  may  be  an 
old  result  without  there  being  at  present  any  misdirected  energy  or  life  at  the 
point  of  lesion. 

I would  then  have  the  patient  on  his  back  and  would  stretch  the  lower 
part  of  his  spine  by  taking  one  of  his  limbs  and  my  assistant  the  other,  and 
working  both  limbs  up  toward  the  chest,  thus  getting  a purchase  on  the  lower 
part  of  the  spine.  You  are  not  very  likely  to  hurt  the  patient  but  you  must 
be  careful  because  different  people  are  different  in  that  respect,  and  yon  may 
do  considerable  hurting,  if  not  actual  damage,  in  that  way.  Again,  if  you 


47 


have,  such  a case  you  want  to  bring  traction  on  the  spine  as  much  as  possible; 
and  it  is  a very  good  way  also  to  take  hold  of  the  patient  by  the  occipital 
protuberance  and  the  inferior  maxillary  so  as  to  exert  traction  enongh  there 
to  pull  the  patient  along  the  table.  You  are  not  likely  to  hurt  the  patient 
with  that  degree  of  force,  unless  it  be  a delicate  lady.  Eemember  that  you 
have  already  sprung  the  spine  by  working  all  along  on  each  side.  One  pre- 
caution you  must  observe  when  you  have  the  neck  extended  in  this  way,  re- 
member that  the  neck  is  less  snpported  than  the  other  x>arts  of  the  spine,  and 
if  you  should  twist  at  that  time  you  might  cause  a dislocation,  the  articular 
Xirocesses  might  slix>  out  of  x^lace,  so  it  is  advisable  not  to  attemxit  to  twist 
when  you  have  it  extended.  If  you  wish  to  twist  the  neck,  do  it  when  the 
sx^ine  is  not  nnder  traction.  In  order  to  be  thorough  the  treatment  must  be 
apx^lied  to  the  whole  length  of  the  sx^ine,  and  when  you  had  the  patient  upon 
his  face  you  would  have  loosened  ux)  the  muscles  along  the  lower  regions  of 
the  spine,  the  sacrum  and  coccyx.  You  may  get  considerable  force  by  put- 
ting the  knee  against  the  sacro-iliac  articulation  and  sxu'inging  the  x^elvis. 
You  must  relax  all  the  ligaments,  you  should  loosen  ux)  all  about  it  as  weU  as 
further  above.  Eemember  that  your  work  has  been  simxily  to  loosen  np  parts 
which  throngh  misdirected  life  have  been  drawn  together.  Of  course,  when 
you  have  such  a condition  you  may  have  almost  any  result,  that  is,  results 
affecting  the  body  through  the  nerves  in  almost  any  way.  As  a general  rule 
I think  you  will  find  that  the  results  may  not  be  marked,  but  may  be  general, 
and  you  may  have  a case  of  general  malnutrition,  or  neurasthenia,  or  some- 
thing of  that  kind.  I would  then  set  the  patient  on  a stool  and  use  the  mo- 
tion I showed  you  at  the  last  lecture,  then  yon  can  get  hold  along  the  sx^ine, 
generally  it  is  better  to  work  from  the  bottom  nx>,  though  it  does  not  make 
much  difference;  I jnst  hold  in  there,  bend  back  a little  and  bring  straight 
traction  as  I ascend  the  column.  That  is  a very  good  way.  You  may  x^ro- 
duce  the  same  result  and  I think  get  a little  better  stretching  motion  by  taking 
a turn  as  yon  work,  you  would  be  more  likely  then  to  stretch  all  the  liga- 
ments about  the  vertebrm. 

In  case  you  have  a sx^ine  misxDlaced  anteriorly,  you  will  have  something 
which  is  rather  difficult  to  deal  with.  In  sirch  a case  you  must  depend  hugely 
ux^on  the  effects  of  the  general  strengthening  which  you  give  to  the  x^arts  to 
work  the  sx^ine  out  into  its  normal  x^osition,  as  you  must  in  other  cases 
also.  But  when  you  have  the  sx)ine  anterior  it  is  very  difficult  to  get  hold  of 
the  vertebra  or  to  influence  it.  However,  Mrs.  Dr.  Patterson  makes  a x^oint 
of  getting  hold  of  the  sx^ine  as  much  as  possible  and  working  at  it.  In  case 
of  dislocations  of  cervical  vertebrm  it  is  a good  x^oint  to  examine  internally, 
and  when  the  dislocation  is  considerable  you  may  find  a xu'otrnsion  into  the 
XJharynx.  In  such  a case  you  would  use  not  only  the  method  I told  you  of. 
trying  to  reach  the  sx^ine,  bnt  would  thoroughly  manixiulate  every  x^oint  about 


48 


it,  and  vould  spring  it  each  way.  Yon  might  also  sit  the  patient  down  and 
go  through  the  lifting  motion.  There  is  one  other  method  that  I think  would 
be  helpful,  that  is,  your  spine  being  anterior,  and  going  upon  the  principle 
that  we  sometimes  adoiJt,  of  exaggerating  the  defect,  you  could  bend  the  pa- 
tient backward,  and  by  placing  the  knee  in  the  back  and  raising  the  arms 
above  the  head  (you  must  be  careful  with  this  motion)  that  would  exaggerate 
the  defect,  it  would  loosen  the  ligaments  along  the  anterior  part  of  the  spine 
which  are  already  stretched,  and  which  you  wish  to  stretch  a little  more  in 
order  to  get  the  effect  of  the  recoil,  and  then  by  relaxing  and  allowing  the  pa- 
tient to  drop  forward  again  we  get  the  recoil.  Then  there  is  another  point 
which  I think  will  be  helpful  to  you,  it  is  practically  the  same  as  I showed 
you,  as  you  work  along  the  spine,  the  idea  is  that  you  get  the  bodies  of  the 
vertebrm  to  move  one  upon  the  other.  Mr.  Bolles  first  spoke  of  this  to  me. 
You  get  the  same  resirlt  as  when  you  move  your  body  by  working  your  feet 
along  the  floor.  I think  you  may  very  readily  get  such  a result  by  working 
the  bodies  of  the  vertebm  on  against  the  other. 

In  case  there  is  a spine  posteriorly,  what  would  you  do?  I take  up  these 
points  in  detail  as  I went  over  them  in  examination  of  the  spine,  although 
the  method  of  treatment  is  largely  the  same.  If  the  spine  is  posterior  you 
would  bend  your  patient  in  this  way,  simply  to  exaggerate  the  defect  and 
then  you  could  turn  him  to  either  side  and  get  the  effect  of  the  recoil  by  ijush- 
ing  him  backward.  Of  course  in  such  case  you  must  be  careful  not  to  use 
too  much  force  and  not  to  strain  the  parts  beyond  what  they  would  normally 
stand. 

In  examination  of  the  spine  I spoke  to  you  concerning  the  ligamentuin 
nuchae  and  the  importance  it  sometimes  bears  in  our  treatment  of  the  spine, 
mentioning  the  fact  that  I have  often  found  cases  of  headache  which  would 
yield  to  treatment  only  when  the  ligamentum  nnchae  was  relaxed . By  care- 
fully examining  along  the  furrow  just  below  the  occipital  protruberance  you 
mav  find  that  the  ligament  is  tense,  you  may  find  that  it  presents  a firm  re- 
sistance to  the  hand  ; the  patient  can  also  feel  it  by  stretching  the  head  for- 
ward ; he  will  feel  that  the  ligament  is  tense.  Naturally,  in  projecting  the 
head  forward,  one  should  not  feel  a sense  as  of  a check  rein  there,  but  in  case 
of  cold  I have  frequently  found  it  distinctly  upon  myself,  have  felt  a sense  of 
tightness  along  that  region- of  the  neck,  and  by  examination  with  the  band  there 
I came  to  the  conclusion  that  there  was  no  other  reason  for  the  trouble  than 
that  the  ligament  was  tense,  and  I think  that  that  was  really  the  fact.  The 
way  to  stretch  that  ligament  is  very  simple.  I usually  just  flex  the  head  di- 
rectly upon  the  thorax,  admonishing  the  patient  to  lie  with  his  weight  down, 
just  to  let  his  weight  f-all  against  my  hands,  and  I raise  up  in  that  wa}'  with 
sufficient  force  to  raise  the  shoulders  off  the  table.  That  would  be  a good 
movement  to  adopt  in  stretching  of  the  spine  when  the  whole  spine  was  smooth 


49 


or  tense.  That,  together  with  flexing  of  the  two  knees  against  the  shoulders 
would  make  a very  good  extension  movement.  In  such  a case  of  tightening  of 
the  spine  it  is  a good  idea  to  advise  your  patient  to  hang  himself,  not  literally, 
hut  to  catch  hold  of  his  closet  shelf  or  the  top  of  the  door  jam  and  bring  the 
weight  of  his  body  upon  his  arm  muscles.  That  would  tend  to  relax  the  spine, 
and  it  is  a very  good  way  to  relax  the  lumbar  portion  of  the  siiine,  as  it  is  not 
so  much  supported  by  attachment  to  the  shoulders  as  the  upper  parts  of  the 
back,  from  the  twelfth  dorsal  up.  I have  often  heard  Dr.  Harry  Still  advise 
some  such  stretching  motion. 

Q.  When  you  have  relaxed  the  structures  along  a smooth  spine,  would 
you  give  the  stretching  treatment  at  the  same  treatment? 

A.  Yes,  sir. 

Q In  the  case  of  a vertebra  being  anterior,  placing  the  knee  on  the 
spine,  would  you  put  it  above  or  below  the  vertebra  that  was  anterior? 

A.  Well  generally  just  about  that  point.  You  of  course  regulate  your 
force,  and  I do  not  think  you  are  in  any  danger  of  pushing  it  further  forward, 
but  the  general  idea  there  is  not  to  bring  pressure  upon  that  point,  so  much  as 
to  give  a fulcrum  against  which  to  work,  and  letting  the  general  tendency  of 
the  forward  motion  of  the  spine  do  the  work. 

Q.  Would  stretching  the  ligamentum  nuchae  have  a tendency  to  get  pos- 
terior curvature  out  between  the  shoulders? 

A.  Partly  so,  though  we  do  not  usually  pursue  that  method  for  that  par- 
ticular thing.  It  would  help. 

Q.  In  stretching  the  ligamentum  nuchae  forward,  is  there  any  danger  of 
acting  upon  the  nerves  that  go  to  the  stomach? 

A.  I have  never  found  any  trouble  in  that  way ; I hardly  think  there  would 
be,  unless  in  case  of  defect,  as  you  thus  stretch  the  whole  spine,  you  might 
get  an  effect  upon  the  splachnics. 

Q.  In  case  of  anterior  displacement  of  the  4th  cervical,  would  the  stretch- 
ing of  the  ligamentum  nuchae  have  a tendency  to  draw  it  out? 

A.  It  would  not  have  much  of  a tendency  to  do  that,  it  is  true  there  are 
slips  that  run  down  to  those  vertebrae,  but  you  would  hardlj^  get  enough  ten- 
sion by  those  slips  to  bring  tension  upon  the  vertebrae. 

Q.  In  separation  of  the  spines  there  is  a weakness  of  the  ligaments  and 
in  approximation  there  is  tenseness,  and  our  treatment  seems  to  be  very  much 
alike,  how  do  we  know  that  the  same  treatment  will  cause  an  opposite  effect? 

A.  That  is  good  question.  Of  course  there  is  a certain  lesion,  in  one 
case  there  is  an  approximation,  in  the  other  a separation;  there  would  be  no 
trouble  in  diagnosis.  You  must  not  misunderstand  the  use  of  the  terms,  too 
much  or  too  little  life  directed  to  a point.  That  is  true,  but  there  may  be  ex- 
ceptions, in  case  of  a sudden  w'reneh  or  jerking  of  the  vertebrae  apart,  which 
frequently  happens,  there  would  not  necessarily  be  a relaxation  of  the  liga- 


50 


ments ; but  that  is  a general  metbod  of  reasoning,  I have  mentioned  it  for  the 
sake  of  its  importance.  But  as  to  your  question  how  we  could  get  the  differ- 
ent effect  by  practically  the  same  treatment,  it  simply  amounts  to  this : that  in 
each  ease  you  are  trying  to  stimulate  parts ; in  one  ease  where  there  is  a tight- 
ening of  the  ligaments  you  use  a stretching  motion  to  draw  them  apart in  the 
next  ease  where  they  are  separated,  granting  there  is  too  little  life  there,  you 
wish  to  stimulate  them  by  stretching  them,  and  getting  the  benefit  of  the  recoil 
and  throwing  more  life  to  the  part. 


LECTURE  X. 


At  the  last^  lecture  I brought  out  the  point  that  from  the  preceding  argu- 
ments it  became  apparent  that  the  whole  field  of  nerve  force  was  open  to  the 
Osteopath,  and  that  the  probability  was  that  th^re  was  no  nerve  in  the  body 
which  he  could  not  manipulate  either  directly  or  indirectly,  thus  opening  up 
to  him  the  whole  field  of  nerve  life.  That  the  question  of  degree  of  stimula- 
tion was  not  an  important  one,  since  the  Osteopath  manifestly  could  stimulate 
or  inhibit,  that  is,  could  affect  the  nerve  in  such  a way  as  to  gain  the  desired 
end.  I then  quoted,  from  certain  texts,  one  from  Kirk  concerning  an  experi- 
ment upon  a rabbit’s  ear,  section  of  the  nerve  followed  by  vaso-dilatation  of 
the  ear,  he  showing  that  the  same  thing  could  be  done  by  pressure  of  the 
thumb  nail  upon  the  nerve.  Also  a quotation  from  Green  concerning  the  re- 
flex process  being  generally  due  to  stimulation,  which  might  be  applied  me- 
chanically. The  general  idea  of  those  quotations  being  to  show  that  we  could 
from  the  books  get  authority  for  what  we  have  been  arguing.  That  that  did 
not  limit  us,  since  we  have  shown  that  we  can  gain  results  in  every  part  of 
the  body;  hence,  we  are  not  limited  to  the  same  kind  of  experiments  as  the 
physiologist  when  he  gains  results  by  external  experimentation,  but  since  w’e 
can  reach  the  whole  body,  we  are  privileged  to  say  that  we  can  stimulate  the 
nerves  in  any  part  of  the  body.  To-day  we  continue  the  same  subject. 

I.  Theory  OF  Osteopathic  Work  Upon  Centers.  (Continued.) — 
The  subject  grows  under  my  pen,  and  I do  not  know  but  what  there  will  be 
several  more  lectures  before  we  shall  have  concluded  the  subject.  I have 
been  calling  your  attention  to  the  fact  that  the  view  I gave  you  of  mere  stim- 
ulation or  inhibition,  direct  or  indirect,  was  not  the  important  thing  that  the 
Osteopath  considers  when  working  upon  nerve  centers.  I have  reserved 
that  until  now,  calling  it  the  second  view  taken, by  the  Osteopath  in  regard 
to  stimulation  or  inhibition  of  nerve  action.  This  is  that  by  the  removal  of 
lesion,  that  is,  some  obstruction  which  has  been  preventing  the  direct  flow  of 
blood  or  nerve  force,  the  tendency  toward  the  normal  is  left  free  to  act.  And 
that  is  the  kernel  of  our  work,  I believe.  Xot  that  we  do  not  do  the  other 


51 


things,  but  I wish  to  lay  stress  upon  the  fact  you  must  look  for  lesions,  and 
having  found  the  lesion  and  having  removed  it,  you  do  not  have  to  stop  to  con- 
sider whether  it  is  stimulation  or  inhibition  that  you  must  produce.  After  you 
have  the  lesion  removed  you  have  the  ever  present  tendency  toward  the  normal 
to  regulate  the  activity,  and  leave  Nature  to  do  the  work.  In  case  the  lesion 
or  obstruction  had  been  such  as  to  inhibit  nerve  action  or  lessen  the  conduc- 
tivity of  the  nerves,  and  thus  prevent  the  proper  conduction  of  nerve  impulses, 
and  you  removed  that  lesion,  the  result  would  practically  be  stimulation.  For 
instance,  you  might  have  had  the  tightening  of  the  spine  along  the  region  of 
the  upper  splachnics  resulting  in  an  imgingement  upon  the  branches  connecting 
with  the  sympathetics  in  that  region,  thus  interfering  with  the  nerve  force  to 
the  solar  plexus  and  to  the  stomach.  The  result  might  be  a ease  of  dyspepsia. 
There  you  have  an  inhibition  of  nerve  force  ; you  have  not  enough  life  to  digest 
the  food  put  into  the  stomach.  When  you  have  removed  that  obstruction, 
what  have  you  done?  You  have  taken  away  that  obstruction,  you  have  left 
Nature  free  to  act,  and  she  will  go  about  stimulating  and  renewing  the  nerve 
force  at  that  point.  What  you  did  was  to  correct  the  lesion,  you  did  n<>t 
stimulate  nor  inhiliit,  you  did  not  care  about  that  particular  point  in  your 
treatment.  On  the  other  hand,  if  the  lesion  has  been  just  sufficient  to  bring 
irritation  upon  the  nerve  and  to  keep  it  stimulated  to  an  abnormal  degree  of 
activity,  that  is  what  you  would  call  abnormal  stimulation  of  the  nerve,  then 
by  removal  of  the  lesion,  you  would  obtain  the  result  of  inhibition.  That  is. 
you  would  remove  the  irritation,  leaving  free  the  tendenc}^  toward  the  normal 
to  act,  and  the  result  of  Nature’s  work  would  be  a quieting  of  the  nerve,  and 
thus  a cure.  You  have  simply  corrected  the  lesion.  A very  familiar  example 
of  such  a condition  is  in  female  troubles;  you  may  have  an  uterine  tumor  af- 
fecting the  hypogastric  plexus,  disturbing  the  kidneys.  If  that  tumor  is  taken 
down  or  removed  the  result  would  be  stimulation,  but  3’ou  have  simply  corrected 
the  lesion.  That  is  the  most  important  thing  that  the  operator  does  ; he  re- 
moves lesions  in  the  great  majoritj-  of  cases.  The  lesion  may  be  lack  of  nutri- 
tion, that  is,  of  blood-supply  to  the  nerve;  it  may  be  a displacement  of  some 
important  part,  bringing  direct  pressure  upon  the  nerve.  No  matter  what  the 
lesion  may  be,  the  Osteopath’s  knowledge  of  anatomy-,  and  his  trained  sense  of 
touch  enable  him  to  discover  abnormalities  in  anatomy  and  gives  him  his  pe- 
culiar adaptibility  for  the  treatment  of  disease.  I do  not  know  that  it  is  be- 
cause we  are  any  wiser  than  physicians,  because  I do  not  think  we  are,  but  it  is 
because  our  svstem  differs  from  others  radically  ; we  look  at  disease  from  an 
entirely  different  standpoint.  I hope  later  to  take  up  that  subject,  the  differ- 
ent systems  and  schools  of  medicine  and  their  modus  operandi.  The  result  of 
our  method  is  that  we  make  a correct  diagnosis  of  the  ease.  You  remember 
that  Dr.  Hildreth  put  especial  emphasis  upon  that:  stating  that  the  strong 
point  ot  Osteopathy  is  that  we  make  a correct  diagnosis;  that  we  diagnose 


52 


from  a physical  standpoint.  In  the  ^reat  majority  of  cases  the  Osteopath 
diagnoses  and  removes  some  displacement,  hence  the  impoi-tauce  of  looking  for 
the  lesion  in  every  case.  To  illustrate  the  difference  between  the  position  taken 
by  our  medical  friends  and  our  position  : When  I was  visiting  at  home  about 

a year  ago,  a young  man  called  on  me  to  be  examined.  It  was  the  same  old 
story  of  a dislocated  hip,  the  leg  being  shorter  than  it  ought  to  be  by  about 
an  inch,  and  there  being  a tumor  upon  the  side  of  the  sacrum,  made  of  course 
by  the  pi'otrusion  of  the  head  of  the  femur.  Now,  he  told  me  how  the  acci- 
dent had  happened,  he  had  had  cj^uite  a severe  fall  from  a wagon.  He  told  how 
the  doctor  had  examined  him,  simply  by  setting  him  on  the  other  side 
of  the  room  and  questioning  him.  That  illustrates  the  difference  in 
our  methods.  You  will  find  that  in  your  practice,  there  will  not  be  a month 
pass  but  that  you  will  find  some  similar  ease  where  the  doctor  has  simply  sat 
across  the  room  and  questioned  the  patient  and  has  not  made  a thorough  physi- 
cal diagnosis.  So  if  you  will  take  the  trouble  and  will  thoroughly  acquaint 
yourself  with  texts  on  physical  diagnosis,  I think  you  will  be  amply  repaid. 

By  quoting  from  the  operators  in  the  building  I wish  to  show  that  they  be- 
lieve that  we  reach  centers  and  affect  nerve  force  directly  by  the  removal  of 
lesions.  I quote  first  from  Dr.  Hildreth:  “In  the  first  place,  where  a lesion 
may  exist,  by  manipulation  or  rather  by  Osteopathic  treatment  you  reduce  the 
lesion,  you  re-establish  a natural  circulation,  and  in  so  doing  you  carry  away 
any  obstruction  which  may  exist.  Y^ou  thus  remove  the  obstruction  to  nerve 
centers.  If  there  be  a contracted  condition  of  muscles,  it  affects  these  centers  ; 
the  dislocation  of  a vertebra,  or  recent  injury  of  tissues  sometimes  without  dis- 
locations, all  these  conditions  may  produce  disease  of  the  different  nerve  cen- 
ters of  the  spine,  and  the  effect  of  0.steopathie  treatment  in  all  these  conditions 
is  to  help  to  re-establish  a natural  nerve  current,  thereby  restoring  a normal 
condition  of  circulation,  thus  relieving  all  tensions  on  nerve  centers.  With 
this  done  gradually  health  cannot  help  but  follow,  for  a healthy  condition  is  a 
natural  condition.”  Thus  you  see  that  Dr.  Hildreth’s  idea  is  that  the  Osteo- 
path adjusts  abnormalities  existing  in  the  anatomy  and  simply  leaves  Nature 
free  to  restore  a condition  of  health.  I wish  to  add  this  in  addition  to  what 
Dr.  Hildreth  has  said : In  some  few  cases  you  will  find  that  all  that  is  necessa- 
ry to  do  is  to  stimulate  the  blood  supply.  The  blood  supply  acting  through  a 
longer  or  shorter  time  removes  the  lesion.  What  you  have  done  in  that  case 
was  not  to  remove  the  lesion,  but  you  have  stimulated  the  blood  supply,  which 
you  have  done  through  direct  manipulation  of  the  nerves  controlling  circula- 
tion. In  that  case  the  matter  is  reversed,  the  cart  before  the  horse.  Y"ou 
have  to  do  this  in  the  case  of  rheumatism,  where  there  are  deposits  in  articula- 
tions. That  of  course  is  not  a primary  lesion,  but  it  is  a lesion.  Y"ou  must 
stimulate  the  blood  flow  so  that  it  will  absorb  those  deposits.  We  sometimes 
absorb  small  absi-esses,  or  thickening  parts  in  that  way.  You  first  remove  the 


primary  lesion,  and  then  the  secondary  result  has  been  to  remove  the  other  le- 
sion. Of  course  we  cannot  always  hrin»  things  down  to  fit  theories.  I quote 
further  from  Dr.  McConnell:  -‘Our  Osteopathic  work  is  largely  performed  in 
correcting  lesions  involving  nerves  or  nerve  centers,  also  in  correction  of  le- 
sions of  the  arterial,  venous,  lymphatic,  and  other  fluids  that  bear  a relation  to 
such  centers.  In  some  few  cases  we  simply  correct  lesions  of  nerves  passing 
from  or  to  the  brain,  or  the  cord,  or  sympathetic  chain,  from  or  to  the  organ 
affected.”  Thus  you  see  that  Dr.  McConnell’s  idea  is  that  we  work  upon 
nerve  centers,  but  that  we  do  it  by  affecting  either  the  fluids  of  life  or  the 
nerve  forces  of  life.  His  idea  being,  of  course,  that  we  remove  lesions,  as  his 
words  imply.  He  also  says  that  we  sometimes  work  to  restore  organic  activity 
or  health  by  removing  a lesion  through  a nerve,  that  is,  independent  from  its 
center.  That  is,  you  may  have  a pressure  upon  a ueave,  and  removal  of  that 
lesion  may  not  affect  the  center.  From  Dr.  Turner  Hiilett  I quote  as  follows : 
“Pressure  upon  a nerve  fiber  would  cause  a break  in  the  eoutiniiity  of  the  .semi- 
fluid axis  cylinder  and  the  damming  back  of  its  current  upon  its  center  of  sup- 
ply. If  any  abnormality  exists,  then  the  ever  present  tendency  toward  the 
normal  will  tend  to  restore  normal  conditions.  If  the  previous  condition  was 
abnormal  stimulation,  then  inhibition  or  desensitizatiou  was  accomplished;  if  it 
was  sub-normal,  then  stimulation  was  accomplished.”  This  expresses  very 
nicely  what  I have  tried  to  show  you,  that  whether  you  stimulate  or  inhibit  de- 
pends upon  the  nature  of  the  lesion  that  you  remove.  I might  quote  further 
from  other  operators,  but  lack  of  space  forbids.  I hope  this  subject  is  not 
growing  threadbare.  We  hear  a great  deal  about  removal  of  lesions  and  stim- 
ulations, etc.,  and  perhaps  yon  get  a little  tired  of  it,  but  I think  it  important 
to  get  these  things  correlated  in  some  definite  system  of  argument,  so  that  we 
may  have  together  the  points  relative  to  Osteopathy. 

We  have  thus  answered  two  of  three  questions  propounded.  First,  what 
does  the  Osteopath  mean  when  he  says  he  “stimulates  or  inhibits;”  Second, 
how  does  be  affect  internal  life  by  manipulation  upon  the  outside  of  the  body : 
and  we  have  partly  answered  the  third  ; How  does  he  affect  centers.  I have 
taken  this  up  in  detail  because  these  questions  are  some  of  the  most  bother- 
some to  the  young  Osteopath,  and  to  the  older  ones  as  well,  sometimes,  and  if 
you  are  prepared  with  arguments,  you  may  retain  many  a patient  by  explain- 
ing these  things  to  him  in  a logical  way. 

Now,  as  to  how  we  work  upon  centers,  I wish  to  carry  the  argument  a lit- 
tle further.  From  what  I have  quoted  from  Doctors  Hildreth,  Hnlett  and  Mc- 
Connell you  see  that  they  believe  that  we  work  upon  centers  first,  by  the  re- 
moval of  lesions  or  obstructions,  and  second,  bj"  direct  stimulation,  and  I think 
there  is  no  doubt  but  that  we  do  affect  centers.  What  I have  quoted  from 
them  was  given  to  me  in  reply  to  the  question,  “How  do  you  affect  centers  in 
the  spine?”  I wish  to  call  your  attention  to  the  fact  that  the  conclusion  is  in- 


evitable  from  what  has  been  said  that  we  must  reach  nerve  centers,  not  simply 
nerves  alone.  Certain  facts  which  we  show  bear  out  this  conclusion . Speak- 
ing of  the  sympathy  between  the  area  that  is  supplied  by  the  5th  nerve  and  the 
area  which  is  supplied  by  the  vagus  nerve,  Dr.  Jacobson,  Dr.  Hilton’s  editor, 
says : “This  sympathy  is  an  example  of  a reflected  sensation  in  which  the  con- 

nection between  the  nerves  concerned  takes  place  in  the  nervous  center.” 
Thus  yon  have  your  effect  running  up  one  nerve  through  a brain  center  and 
down  another  nerve.  Now,  if  you  have  a lesion  affecting  the  periphery  of  one 
of  these  nerves  and  you  remove  that  lesion,  you  have  naturally  affected  the 
center  in  the  brain,  there  is  no  doubt  whatever  of  that.  He  gives  a case  of  ob- 
stinate vomiting  in  a child,  which  was  cured  by  simply  removing  from  each  ear 
of  the  child  a bean  which  had  been  introduced  in  play.  There  was  a stimula- 
lation  of  the  5th  nerve,  the  impulse  must  have  gone  through  the  floor  of  the 
4th  ventricle  out  over  the  vagus  to  the  stomach.  Of  course  there  is  a connec- 
tion of  the  5th  nerve  and  vagus  by  means  of  the  sympathetic,  but  it  is  indirect, 
and  it  is  probable  that  the  nerve  center  was  the  connecting  link,  as  Dr.  Jacob- 
son says.  Again,  we  must  reach  nerve  centers,  because  by  the  very  definition 
of  reflex  action,  which  we  know  is  an  action  caused  bj-  an  impulse  sent  back 
along  a nerve  to  a center  and  then  out.  From  its  very  definition,  if  we  cause 
reflex  action  by  manipulation,  the  inference  is  inevitable  that  we  affect  centers. 
That  we  may  do  this  is  shown  in  performing  the  experiment  for  tendon  reflex. 
This  is  very  easily  done  by  crossing  the  leg  at  about  right  angles  and  then  get- 
ting the  reflex  by  tapping  the  tendon.  That  is  a reflex  action.  You  have  sent 
the  impulse  from  the  nerve  endings  in  the  muscle  back  to  the  center  in  the 
cord  which  governs  the  nerve  supply  of  the  muscles  of  the  limb,  the  gluteal 
muscles  have  contracted  and  thrown  the  limb  out.  So  you  have  afiiected  the 
center.  Again,  every  time  we  set  up  a vaso  motor  action  we  have  probably 
acted  upon  a center.  Howell’s  Text  Book  says  that  vaso-motor  nerves  can  be 
excited  reflexly  by  afferent  impulses  conveyed  either  from  the  blood  vessels 
themselves,  or  from  end  organs  of  sensory  nerves  in  general.  Of  course  the 
thing  is  proven  the  moment  you  show  that  vaso-motor  actions  are  reflex  actions 
I have  instanced  here  the  bleeding  of  the  nose,  epistaxis,  stopped  by  irritating 
the  superior  cervical  ganglion  of  the  sympathetic ; simple  stimulation  of  the 
neck  at  that  point  has  stopped  bleeding  of  the  nose.  The  conclusion  is  that 
you  have  acted  through  a nerve  center. 

I have  shown  first,  that  we  affect  a nerve  and  its  area  of  distribution  direct- 
ly, instancing  the  result  of  pressure  of  the  ulnar  nerve  where  it  crosses  the 
“crazy  bone”  so-called,  thus  you  have  numbness  in  the  hand;  you  have  affect- 
ed that  nerve  in  its  area  of  distribution  directly,  not  through  a center.  Second, 
we  affect  a center  by  removal  of  a lesion,  the  beans  in  the  ear  being  the  exam- 
ple cited.  And  third,  we  affect  a center  without  removal  of  lesion,  but  by  the 
effeect  upon  the  nerve,  as  in  the  ear  of  the  rabbit,  there  was  no  lesion  i-emoved 


when  we  press  on  the  nerve,  we  acted  on  the  nerve  back  through  the  center 
and  got  our  effect.  Those  are  at  least  the  three  different  ways  in  which  we 
may  affect  nerve  action. 

II.  How  to  Treat  a Spine.  (Continued.)  I have  examined  this  gentle 
man  and  find  the  curves  of  his  spine  are  not  normal.  What  I wish  to  do  is  to 
work  inward  this  curve  in  the  lumbar  region,  and  wish  to  make  more  pro- 
nounced this  curve  in  the  upper  dorsal  region,  because  it  is  flattened,  while 
the  other  is  drawn  out  a little  posteriorly,  thus  you  have  a somewhat  staight 
spine.  At  the  risk  of  being  tiresome  I bring  these  points  up  in  detail  as  I took 
them  up  in  examination  of  the  spine.  I think  you  know  what  to  do  here  as 
well  as  I ; I have  shown  you  how  to  approximate  or  spread  vertebrae,  and  you 
would  treat  by  a combination  of  the  methods  I have  shown  you ; the  relaxation 
treatment  with  the  patient  on  his  face,  or  springing  of  the  spine  all  along,  the 
relaxation  of  the  ligaments  and  muscles,  and  thus  of  the  blood  and  nerve  force 
to  those  parts.  By  a combination  of  those  treatments  you  would  tend  to 
strengthen  the  normal  curves.  You  would  thus  remove  the  lesion,  which 
would  be  the  tightening  or  tension  that  had  thrown  them  out  of  their  normal 
curves,  and  would  leave  nature  free  to  act.  You  cannot  quickly  replace  those 
vertebrae  in  their  normal  curves ; you  must  strehgthen  gradually  and  build  up 
the  spine  in  order  that  it  may  take  its  normal  position.  This  tendency  toward 
the  normal  is  of  great  use  to  the  Osteopath. 

You  may  find  the  coccyx  in  almost  any  position,  either  anterior  or  to  one 
side.  What  you  must  do  is  to  give  a local  treatment.  The  method  of  digital 
treatment  is  to  first  place  the  finger  along  the  natural  curve  of  the  coccyx,  and 
by  working  from  side  to  side  free  up  all  the  ligaments  and  tissues  thereabout. 
In  this  way  you  loosen  everything  over  the  foramina  where  the  nerves  emerge, 
or  any  binding  down  which  may  have  occurred  over  the  nerves  directly.  You 
have  inserted  the  finger  and  have  turned  it  so  that  you  have  simply  worked 
every  side ; you  must  thoroughly  relax  before  attempting  to  reset.  This  must 
be  done  not  only  internally,  but  you  must  thoroughly  relax  all  the  muscles  ex- 
ternally. It  will  take  some  time,  but  you  can  at  each  time  you  treat  the  pa- 
tient bend  the  coccyx  toward  its  proper  position.  Of  course  there  are  lesions 
of  the  coccj'x  which  may  be  set  immediately.  In  general,  it  is  recent  disloca- 
tions that  yield  thus  quickly  to  treatment.  When  it  is  chronic,  as  it  usually 
is,  the  man  usually  did  it  when  he  was  a boy  riding  horse  back  or  some  such 
way,  you  will  have  to  go  slowlJ^  Suppose  the  coccyx  were  tending  to  be 
slightly  curled  up,  as  is  frequently  the  case,  you  must  simply  spring  it  back- 
wards each  time.  You  must  go  according  to  the  conditions,  and  must  con- 
stantly spring  the  spine  toward  its  proper  position.  I think  I explained  the 
troubles  which  may  follow  this  displacement,  and  I do  not  need  to  take  them 
up  now. 

The  sacrum  may  be  anterior  or  posterior.  I shall  take  that  upi  more  in  de- 


56 


tail  when  we  come  to  the  consideration  of  the  pelvis  itself.  But,  supposing  it 
were  posterior,  we  would  at  first,  of  course,  loosen  up  all  the  tissues,  muscles, 
and  ligaments,  and  then  adopt  the  method  that  I showed  the  other  day — get 
your  knee  against  the  bulging  portion  and  spring  it  inward,  a direct  application 
of  the  treatment  to  the  displaced  part.  It  is  a good  deal  like  putting  a coccyx 
back  into  place ; by  training  it  in  the  way  it  should  go.  Now,  you  may  also 
get  the  same  motion  that  I showed  you  and  spring  the  saero-iliac  articulation  in 
this  way.  Then  have  the  patient  lie  on  his  back  and  you  can  get  a very  good 
motion  for  the  sacrum  in  this  way : Tour  hand  is  placed  in  this  position  ; the 

knuckles  forming  one  fulcrum  and  the  tips  of  the  fingers  the  other ; there  are 
two  fixed  points,  you  have  the  ends  of  the  fingers  placed  against  the  sacro-iliae 
articulation,  and  your  knuckles  against  the  table.  You  thus  have  two  fixed 
points,  and  you  can  in  this  way  relax,  by  an  upward,  downward  and  outward 
motion  of  the  limb,  all  of  the  muscles  and  ligaments.  The  weight  of  the  pelvis 
is  upon  those  two  fixed  points,  it  gives  a considerable  spring  there,  and  is  a 
very  good  motion.  In  case  the  sacrum  is  anterior,  of  course  it  is  very  hard  to 
apyly  any  direct  treatment  to  it,  but  use  the  motion  I have  just  shown  you  ; 
stimulate  and  relax  every  part,  and  depend  upon  the  tendency  toward  the  nor- 
mal. You  might,  by  getting  pressure  upon  the  side  of  the  pelvis,  spring 
down,  but  I doubt  if  you  could  do  much  in  that  way.  Your  tendency,  how- 
ever, would  be  to  approximate  the  innominates  and  to  cause  it  to  bulge  out. 


LECTURE  XL 


At  the  last  lecture  I continued  the  consideration  of  the  theory  of  Osteo- 
pathic work  on  centers,  calling  to  your  attention  the  second  view  taken  by  the 
operators  as  to  how  we  stimulate  or  inhibit  nerve  action,  the  idea  being  that  as 
a rule  we  remove  some  lesion,  and  that  that  is  our  strong  point  in  diagnosis — 
to  find  some  lesion  which  we  may  reduce  to  the  normal,  and  thus,  if  the  tenden- 
cy before  was  toward  stimulation,  you  have  removed  the  lesion  and  allowed 
nature  to  tend  toward  inhibition,  and  vice  versa.  Thus  yon  do  not  have  to 
split  hairs  over  the  question  as  to  whether  you  employ  a certain  motion  to 
stimulate  and  a certain  other  motion  to  inhibit.  That  is,  as  far  as  lesion  goes; 
you  have  removed  the  lesion.  I quoted  from  different  ones  of  the  operators  to 
show  that  that  was  the  view  generally  held.  I also  called  your  attention,  in 
line  with  what  Dr.  Hildreth  said,  to  the  fact  that  sometimes  you  stimulate 
blood-supply  to  remove  the  lesion,  which  although  secondary  is  still  a lesion ; 
as  for  instance  we  stimulate  the  blood  and  nerve  force  to  remove  deposits  in 
rheumatism,  and  to  cause  absorption  of  abscesses,  and  things  of  that  kind. 
Thus  I had  answered  two  questions  propounded  and  partly  the  third,  as  to  the 
effect  we  have  upon  nerve  centers.  Then  I went  further  into  the  question  of 


how  we  might  affect  centers,  bringing  to  your  attention  the  fact  that  the  quo- 
tations I made  from  the  operators  were  given  in  response  to  that  question,  and 
one  way  was  by  the  removal  of  lesions,  another  way  was  that  in  any  manipula- 
tion of  the  nerve  we  must  very  likely  affect  centers,  as  for  instance,  in  getting 
a reflex  effect,  because  from  the  definition  of  reflex  action  we  must  have  affected 
the  center,  and  we  often  produce  reflex  action  by  work  upon  a nerve,  .not  a cen- 
ter. I instanced  a ease  of  obstinate  vomiting  produced  by  the  irritation  of 
beans  in  the  ears.  The  fact  that  you  have  removed  the  bean  shows  that  you 
reached  the  center ; that  you  worked  through  a brain  center ; up  one  nerve  and 
down  another  nerve  to  the  periphery,  to  the  organ  supplied  by  the  nerve. 
And  the  fact  also  that  we  can  produce  vaso-motor  action  shows  that  we  have 
affected  centers,  since  vaso-motor  actions  are  essentially  reflex.  Thus  I showed 
that  we  may  affect  a nerve  by  three  ways : 1st,  we  may  directly  affect  it  and 
its  area  of  distribution  by  direct  work  ; 2nd,  we  may  affect  the  center  by  re- 
moval of  lesion,  as  when  we  produce  a reflex  action.  To-daj’-  1 continue  the 
same  subject. 

I.  Theory  op  Osteopathic  Work  upon  Nerve  Centers.  (Continued.) 
In  the  December  issue  of  the  Journal  of  Osteopathy,  a theory  was  given  in  an 
article  by  Dr.  Lawrence  M.  Hart,  one  of  our  recent  graduates,  which  I think 
was  worthy  of  notice.  It  was  well  received  at  the  time,  I believe,  and  I have 
thought  that  it  contained  points  which  would  be  worthy  of  our  consideration 
this  afernoon.  His  idea  is  that  we  always  remove  lesions.  His  theory,  in 
brief,  is  this : that  contractures  of  muscles  occur  along  the  spine,  these  con- 
tractures along  the  spine,  he  says,  act  in  a way  to  mechanically  shut  off  the 
blood  supply  in  the  branches  supplying  the  spinal  muscles  themselves,  collat- 
erally producing  a hyperemia  in  the  blood  vessels  running  to  the  cord,  ard  in 
that  way  stimulating  the  nerves,  irritating  them,  and  thus  leading  to  inhi- 
bition, the  final  result  always  being  an  inhibition,  and  the  lesion  always  being 
contracture.  There  are  certain  points  with  which  I do  not  agee,  I will  call 
those  up  later,  but  I will  go  over  the  reasoning  that  he  has  followed,  bringing 
out  his  points.  In  the  first  place,  he  says  there  are  two  ways  in  which  a nerve 
may  be  affected  through  its  blood  supply-,  and  I think  that  is  true.  In  the 
first  place,  3'ou  may  have  anemia  of  the  nerve,  that  is,  total  lack  of  blood  sup- 
ply, thus  robbing  it  of  its  nutrition  and  leading  finally  to  a degenerated  nerve, 
and  thus  paralysis  of  the  part  supplied  follows.  In  the  second  place,  you  may 
have  hyperemia  of  the  nerve,  which  he  claims  leads  to  an  irritation,  there  be- 
ing too  much  blood  thrown  to  the  part,  leading  to  abnormal  activity,  this  leads 
to  too  much  stimulation,  resulting  in  inhibition.  Thus,  in  one  ease  from 
anemia  and  degeneration  you  have  paralysis ; in  the  the  other  case  you  have 
practically  the  same,  an  inhibition  which  is  liable  to  be  more  temporary,  be- 
cause it  is  produced  b,y  an  over-supply  of  blood  and  not  by  starvation.  Thus 
you  see  that  his  argument  leads  always  to  the  one  result  of  inhibition.  He 


58 


calls  our  attention  to  the  distribution  of  the  blood  supply  to  the  spinal  cord, 
showing  how  the  branches  from  the  vertebral,  intercostal  and  lumbar  and  oth- 
er arteries  in  their  respective  regions  run  to  supply  both  the  cord  and  the  spinal 
muscles,  the  same  branch  supplying  both,  that  is,  dividing  to  supply  both,  the 
posterior  division  running  to  the  spinal  muscles,  and  the  other  division  run- 
ning to  the  cord  and  its  membranes.  Thus  he  shows  the  close  relation  between 
the  blood-supply,  and  states  the  fact  that  from  the  occiput  to  the  coccyx,  all  of 
the  muscles  and  parts  of  the  cord  are  thus  supplied.  Now,  his  argument  here 
is  that  m contractnre  of  muscles,  the  lumen  of  the  vessels  being  thus  practical- 
ly closed,  the  over  supply  of  blood  is  sent  through  the  branch  which  supplies 
the  membranes  of  the  cord,  thus  producing  a condition  of  hyperemia  about  the 
cord.  In  the  first  place,  this  would  result  in  throwing  too  much  blood  supply 
to  the  nerves  in  question  and  the  nerve  centers  of  the  cord,  the  result  would 
be  that  by  over  blood  supply  there  would  be  over  stimulation,  leading  finally 
and  naturally  to  an  inhibition  of  nerve  force,  and  thus  you  see  there  would 
always  be  inhibition.  Now,  in  relieving  this  condition  we  of  course  simply 
take  away  the  lesion,  we,  by  our  methods  relax  these  old  contractures,  and  al- 
low a return  of  the  flow  of  blood  through  them,  and  thus  take  away  the  over- 
plus which  is  being  misdirected  to  the  cord  and,  through  the  centers,  effecting 
other  parts  of  the  body.  You  see  that  the  point  is  made  that  we  remove  le- 
sions, and  that  is  one  reason  why  I bring  this  up,  becase  it  illustrates  that  fact. 
Whatever  the  result,  according  to  his  theory,  if  T correctly  understand  it,  we 
have  always  stimulated,  but  that  since  we  remove  lesions  and  then  leave  nature 
to  work,  it  IS  not  an  essential  question  to  ns  whether  we  stimulate  or  inhibit, 
which  I think  is  another  good  point,  because  there  has  been  a good  deal  of 
hair-splitting  as  to  whether  you  should  give  a certain  twist  of  wrist  to  stimu- 
late or  certain  other  twist  of  the  wrist  to  inhibit.  Now,  to  me.  Dr.  Hart’s 
theory  is  valuable  in  bringing  prominently  to  your  attention  this  one  kind  of 
lesion,  contracted  muscle,  and  showing  the  probable  effect  produced.  That  is 
at  least  one  kind  of  lesion  with  which  we  have  to  deal.  He  shows  the  import- 
ance which  we  must  attach  to  this  condition  of  contracted  muscle,  which  we 
frequently  find  along  the  spine.  I doubt  if  there  will  be  a day  in  your  practice 
in  which  you  willl  not  find  such  a condition  along  the  spine.  In  the  criticisms 
I have  to  make,  I do  so  not  to  criticize  the  article,  but  simply  for  the  purpose 
of  bringing  out  the  points  which  I think  will  be  helpful  to  you.  From  his  ar- 
ticle I do  not  gather  that  he  allows  of  other  lesions,  though  perhaps  I am  mis- 
taken. I do  not  think  he  makes  it  general  enough.  Now,  I think  there  are  a 
great  many  other  lesions  along  the  spine  which  will  affect  nerve  centers  and 
nerve  distribution,  and  saying  that  contracture  is  the  only  cause  of  lesion  is 
far  from  correct.  So  that  his  theory  is  true  only  when  the  lesion  is  in  the  na- 
ture of  a contracture,  and  then  I do  not  agree  with  the  explanation,  but  I 
shall  speak  of  that  later.  I wish  to  call  your  attention  further  to  the  fact  that 


59 


we  sometimes  stimulate  and  sometimes  inhibit.  After  you  have  removed  the 
lesion,  you  sometimes  have  to  do  your  Osteopathic  work  upon  parts  affected, 
and  in  those  eases  you  must  stimulate  or  inhibit.  In  the  ease  of  head-ache  we 
frequently  have  to  hold  and,  as  we  call  it,  inhibit  the  neck,  while  in  the  case  of 
epistaxis  we  would  stimulate  the  superior  cervical  ganglion.  Then  again,  to 
remove  the  chalky  deposits  in  rheumatism,  or  in  absorbing  an  abcess,  we  have 
to  stimulate  frequently,  and  in  that  case,  of  course,  it  is  not  a matter  of  re- 
moval of  lesions.  Now,  I have  said  that  I think  the  explanation  of  the  effects 
following  contracture  is  only  partly  true,  and  for  this  reason  ; I believe  the 
theory  is  somewhat  too  mechanical,  making  this  a mechanical  shutting  down 
upon  blood  supply,  and  thus  sending  an  over-plus  to  other  parts.  The  theory 
does  not,  according  to  my  mind,  take  into  consideration  enough  the  mechan- 
ism of  nerve  distribution  to  the  vessels  and  to  the  muscles  of  the  back,  hence 
I have  gone  somewhat  further  and  have  endeavored  to  explain  the  conditions 
which  would  follow  contractures  on  the  basis  of  nerve  influence.  I believe 
that  the  generally  accepted  view  is  that  not  only  the  blood  vessels  of  the  body, 
but  all  the  functions  of  life,  are  directly  under  the  control  of  the  nervous  sys- 
tem, sympathetic  or  cerebro-spinal.  And  hence,  I think  it  would  more  in  line 
with  the  accepted  theory  if  we  could  explain  these  things  according  to  some 
theory  of  nervous  influence  which  they  have  produced.  Now,  it  is  reasonable 
to  suppose  that  there  is  by  contracture  some  vaso-motor  influence  set  up.  Me- 
chanical contracture  would  result  in  stoppage  of  blood  to  the  muscles  along  the 
spine,  and  would,  of  course,  result  in  an  over-plus  of  blood  to  the  cord  and  its 
meninges  through  the  collateral  branches.  That  would  be  inevitable,  but  that 
condition  would  hardly  be  permanent  unless  the  vessels  were  dilated  to  accom- 
modate it,  so  that  we  must  look  for  some  sort  of  a nervous  action  to  account 
for  the  blood  remaining  at  that  place,  otherwise  I believe  that  the  blood  would 
be  distributed  about  the  body,  and  that  collateral  equalization  would  beset 
up,  and  as  you  had  anemia  along  the  spinal  muscles  you  would  have  that  much 
more  blood  in  other  parts  of  the  body:  not  necessarily  just  along  the  spine. 
That  is,  in  case  the  mechanical  theory  holds  true.  But  I believe  you  might 
have  in  such  a case  not  only  hyperemia  of  the  cord,  but  you  might  have  ane- 
mia of  the  cord  and  its  centers.  If  the  muscles  coutaacted  and  shut  off  the 
blood  supply  mechanically  only,  you  cannot  have  anything  but  hyyeremia  : 
but  if  you  regulate  your  theory  according  to  nervous  mechanism,  you  can  have 
either.  There  is  no  question  but  that  contractures  are  important  lesions.  For 
instance  we  have  heart  trouble  caused  by  lesions  along  the  back.  I remember 
having  heard  Dr.  Hildreth  say  that  in  case  of  weakness,  general  debility,  ana 
irregular  heart-action  he  always  looks  on  the  left  side  between  the  shoulders, 
looking  lor  some  contracture  of  muscles  in  that  part,  and  that  such  a condition 
would  usually  make  the  patient  despondent.  Dr.  Hildreth  also  said  that  when 
he  found  such  a lesion  on  the  right  side  of  the  spine  it  usually  makes  the  patient 


GO 


“silly;”  has  the  opposite  effect.  Such  is  Dr.  Hildreth’s  explanation  of  this 
kind  of  lesion  alon^-  the  spine,  and  there  must  be  some  good  explanation  for 
the  results  thus  produced.  Now,  as  I have  said,  to  me  it  seems  very  probable 
that  the  contractures  act  not  so  much  mechanically,  as  through  vaso-motor 
centers  and  fibres  which  they  involve,  and  not  only  that,  but  indirectly  through 
the  nervous  mechanism  of  the  muscles  involved.  I quote  from  Gowers  on  the 
Nervous  System:  “The  sensory  nerves  of  muscles  have  been  shown  by  Tsch- 

irjew  to  commence  not  in  the  muscular  fibres  but  in  the  interstitial  connective 
tissue.”  Then  he  goes  on  to  explain  his  theory  of  why  we  get  a “myostatic 
reflex  action,  the  term  he  has  adopted  for  “tendon-reflex.”  He  says  that  in 
such  a case  the  muscle  is  upon  a tension.  You  remember  in  showing  ,you  how 
to  produce  the  knee-reflex  I crossed  the  knees,  thus  bringing  tension  on  the 
muscles  above  the  knee,  then  if  you  shock  the  muscle  not  necessarily  the  ten- 
don itself,  you  get  the  throwing  out  the  foot.  He  bases  his  theory  on  the  sen- 
sory nerve-endings  between  the  muscle  fibres  being  impinged  upon  by  the 
fibres  themselves.  It  seems  reasonable  to  suppose  that  if  the  muscle  is  in  a 
state  of  tonic  contraction  there  would  be  a pressure  upon  the  nerves ; and  that 
is  a fair  explanation  of  the  sore  spots  we  find  along  the  spine.  Those  sore 
spots  have  been  started  in  a contracture ; it  has  become  axiomatic  that  we 
must  look  for  the  sore  spots  along  the  spine,  and  you  will  find  that  they  coin- 
cide with  the  seat  of  the  lesion,  which  is  the  contracture.  That  theory  would 
account  for  the  spot  being  sore,  that  is,  providing  it  had  not  been  of  too  long 
standing,  in  which  case  if  you  find  it  not  sore  you  might  account  for  it  by  the 
same  theory — that  stimulation  has  gone  on  until  it  is  equal  to  inhibition.  I am 
a good  deal  like  Dr.  Hildreth  when  he  says,  “If  this  theory  does  not  suit  you, 
figure  one  out  for  yourself,”  And  while  I am  endeavoring  to  explain  these 
things  in  as  scientific  a way  as  possible,  if  my  theories  are  not  correct,  it  is 
your  privilege  to  do  better. 

Now,  not  only  would  we  affect  the  terminal  sensory  fibres  in  the  muscles, 
but  we  know  that  there  is  a close  connection  between  the  spinal  nervers  and 
the  sympathetics  and  it  looks  very  probable  that  an  effect  might  be  sent  from 
a muscle  through  its  sensory  terminal  right  through  to  affect  the  sympathetic 
nerves,  and  thus  to  affect  the  general  sympathetic  life,  irrespective  of  any  ef- 
fect you  might  have  through  the  blood  supply  upon  nerve  centers  in  the  spinal 
cord.  Thus  you  get  the  direct  sympathetic  effect  from  the  irritation  of  sen- 
sory nerves.  You  remember  that  I quoted  from  Howell’s  Text  Book  a few 
days  since  to  show  that  nerves  were  frequently  stimulated  through  their  sen- 
sory terminations  in  the  muscles.  Now,  as  I have  said,  I believe  this  contract- 
ure, taking  the  theory  that  it  acts  through  blood  supply,  may  thus  produce 
either  vaso-dilation  or  vaso-contraction,  according  to  the  centers  affected  along 
the  spine.  I here  quote  from  Kirke  : “The  vaso-dilator  nerves  in  part  accom- 
pany those  first  as  described,  but  are  not  limited  to  the  out-flow  from  the  2d 


61 


thoracic  to  the  2d  lumbar.”  Further:  “The  vaso-constrictor  nerves  for  the 
whole  body  leave  the  spinal  cord  by  the  anterior  roots  of  the  spinal  nerves 
from  the  2d  thoracic  to  the  2d  lumbar.”  Hence,  my  argument  is  that  since 
you  have  both  vaso-dilator  and  vaso-constrictor  centers  all  along  the  spine, 
according  to  the  quotation  from  Kirke,  that  acting  on  the  center  affected  you 
might  have  either  a vaso-dilation  or  vaso-constriction  ; you  may  have  anaemia 
or  hyperemia  of  the  center  involved.  That  looks  reasonable  to  me  from  the 
theory  of  nervous  mechanism  of  the  blood  supply.  In  case  the  lesion  were 
such  that  it  brought  this  overflow  of  blood  upon  a vaso-constrictor  center,  that 
center  would  be  stimulated  at  first,  and  the  first  result  would  be  to  shut  < ff  the 
blood  to  the  narts  affected  by  the  contraction  resulting  from  the  over  stimula- 
tion of  that  vaso-constrictor  center.  Thus  you  might  have  anaemia ; the  con- 
strictor may  act  in  such  a way  as  to  entirely  shut  off  the  blood  from  a part. 
Byron  Robinson  is  authority  for  the  statement  that  the  sympathetics  may  crowd 
the  blood  from  a part  even  unto  death.  However,  suppose  that  the  action  has 
gone  so  far  that  the  stimulation  has  resulted  first  in  irritation,  then  in  inhibi- 
tion, so  that  there  is  a paralysis  there,  then  your  constriction  is  lost ; your  di- 
lators are  not  opposed  and  there  would  be  a flooding  of  the  part ; a hyperemia. 
In  line  with  this  theory  I quote  what  Green  has  to  say.  He  says  that  hypere- 
mia of  a nerve  center  leads  to,  first,  an  excessive  nervous  excitability,  together 
with  paraesthesia  of  sight  and  hearing,  and  finally  may  even  lead  to  convul- 
sions. On  the  other  hand,  if  in  the  first  place  the  vaso-dilator  center  be  affect- 
ed, you  would  have  the  dilators  over  stimulated  resulting  in  hyperemia,  but 
when  it  went  on,  finally  resulting  in  paralysis  of  those  dilators,  then  the  unop- 
posed action  of  the  constrictors  would  set  up  an  anemia,  and  that  would  be  a 
permanent  result.  It  would  lead  to  death  of  the  part  paralyzed  from  the  ex- 
cessive anemia  of  the  spinal  centers  and  the.  spinal  nerves.  Thus  you  get  an 
effect  not  only  upon  the  spine,  but  upon  the  whole  distribution  of  that  nerve. 
Thus  you  can  see  what  would  be  the  probable  effect  of  anemia  or  hv|Deremia  of 
the  cord  either  from  this  shutting  down  of  the  contractures  upon  the  blood 
supply,  according  to  one  part  of  the  theory.  The  other  part  of  the  theorj’  be- 
ing that  this  contracture  might  shut  down  directly  upon  the  nerve  and  through 
it  send  the  effect  to  the  part  supplied  by  the  nerve.  Thus  you  see  that  con- 
tractures along  the  spine  may  act  as  stimulator’s  or  inhibitors  mechanically. 
So  in  this  case  we  remove  the  lesion  for  its  own  sake,  and  not  simply  to  stim- 
ulate. 

So  much  for  that  thought.  I wish  to  take  up  another  question  in  relation  to 
blood-supply,  how  it  affects  nerve  life,  and  how,  perhaps,  the  Osteopath  may 
thus  influence  nerve-life  through  blood  supply.  That  is  perhaps  getting  the 
cart  before  the  horse,  according  to  the  previous  argument,  still  from  the  facts 
which  I wish  to  bring  to  your  attention  it  looks  as  though  we  might  accomplish 
this.  This  question  is  not  proven,  but  I tnus  throw  it  out  for  the  sake  of  sug- 


gestiou.  It  may  lead  to  a good  theory  later.  The  quantity  of  natural,  healthy 
blood  in  the  vessels  of  a part  aet  redexly  upon  the  mechanism,  that  is,  the  vaso- 
motor nervous  mechanism,  and  thus  affect  the  parts.  There  would  thus  be  a 
collateral  equalization  of  the  blood  throughout  the  body.  As  I stated,  the 
facts  that  I have  to  give  along  this  line  do  not  strictly  prove  the  point,  and  I 
have  not  tried  to  make  them,  but  they  are  valuable  as  hints.  In  the  first  place, 
if  Dr.  Hart’s  argument  be  true  that  the  effect  of  the  blood  may  be  stimulation 
resulting  in  inhibition,  or  that  it  may  be  inhibition  direct,  then  the  quantity  of 
the  blood  in  a part,  being  drawn  from  the  spinal  muscles  to  the  centers  there, 
the  mere  quantity  of  blood  would  account  for  the  effect  upon  the  nervous 
mechanism.  I use  the  term,  pure,  healthy  blood,  because  I do  not  take  into 
consideration  the  question  of  the  effect  of  deteriorated  blood,  which  you  know 
is  a different  thing.  From  Green’s  quotation  we  see  that  he  considers  the  ef- 
fect of  hyperemia  upon  nerve  centers  produces  paresthesia,  convulsions,  etc. 
Howell’s  Text  Book  states  : ‘-There  is  in  some  degree  an  inverse  relation  be- 

tween the  vessels  of  the  skin  and  of  the  deeper  structures  by  the  reflex  mechan- 
ism of  the  vaso-motor  centers.”  If  superficial  parts  have  their  vessels  dilated, 
deeper  jiarts  have  them  contracted,  the  flow  of  blood  being  regulated  in  dif- 
ferent parts  of  the  body  according  to  conditions.  The  question  is,  what  is 
the  stimulation?  There  was  one  of  our  students  who  conceived  the  idea  that 
the  distribution  of  the  fibres  of  the  solar  plexus  upon  the  blood  vessels  close 
to  the  heart,  chiefly  the  aorta,  were  stimulated  by  the  flow  of  blood  from  the 
heart  into  the  vessels:  that  they  thus  acted  as  vaso-coiistrictors  or  dilators, 
and  thus  propelled  the  blood,  producing  the  rhythmic  beat  of  the  aorta.  This 
student  wrote  to  Byron  Eobinson,  who  replied  that  he  considered  it  a '^eiy 
reasonable  theory.  Hence,  you  may  have  the  quantity  of  blood  thrown  into 
the  aorta  acting  as  a stimulant.  Green  further  notes  the  fact  that  in  hjqier- 
eniia  following  inllamniation,  that  in  other  parts  of  the  body  there  is  collateral 
anemia,  because  there  being  too  much  blood  in  one  place,  there  is  too  little  in 
another  jilace.  As  I said,  I quote  these  facts  as  suggestions,  and  not  for  the 
sake  of  proving  the  theory,  but  if  that  theory  can  be  proven,  it  will  be  im- 
portant to  the  Osteopath;  he  may  mechanically  pump  blood  into  a part,  as 
for  instance  by  flexion  of  the  thigh,  he  might  repeatedly  flex  it  and  pump 
blood  into  it  and  thus  get  a vaso-motor  effect  which  is  mechanical.  Thus,  he 
may  get  a nervous  effect  through  the  quantity  of  blood  sent  to  the  part.  We 
sometimes  make  a ijractical  ai^plicatiou  of  such  a theory  by  working  upon  the 
splanclinics  to  reduce  the  amount  of  blood  in  the  head;  the  parts  governed  by 
the  splauchnics  being  a sort  of  a reservoir  for  an  over- pi  us  of  blood,  and  that 
we  can  wmrk  it  from  one  part  to  another.  These  facts  may  be  taken  for  what 
they  are  worth  and  may  be  suggestions  for  some  of  you. 

11.  How  TO  Treat  A Spine.  (Continued.)  As  to  the  second  part  of  my 
lecture,  I shall  try  to  conclude  this  subject  if  possible.  There  is  one  point  I 


63 


want  to  give  you  in  relation  to  tire  general  treatment  of  the  spine.  AMien 
yon  have  acnte  hyperesthesia,  an  acute  tenderness  all  along  the  spine,  the 
Old  Doctor  treats  in  the  neck,  in  the  cervical  enlargement,  corresponding  in 
general  to  the  spines  of  the  cervical  vertebrm,  and  in  the  lunihar  enlargement 
of  the  cord,  corresponding  to  the  spines  of  the  last  three  or  four  dorsal  and 
the  space  between  the  12th  dorsal  and  1st  lumbar. 

There  is  one  treatment  that  I have  not  shown  you.  It  is  a treatment  I 
have  not  seen  any  of  the  ladies  use.  It  is  a treatment  in  which  the  oiDerator 
simply  brings  his  weight  to  bear  in  this  way.  That  is  what  I have  denomi- 
nated as  the  ‘‘straddling  treatment.” 

I mentioned  to  you  that  we  frequently  get  noises  along  the  spine  which 
are  due  to  motion  between  parts,  and  in  some  cases  that  that  was  due  to  a 
slipping  of  parts  of  the  ribs  to  their  place,  and  when  I have  worked  along  the 
spine  by  getting  direct  j)ressure  over  one  side  only  and  I have  not  been  able 
to  i^roduce  these  noises  with  their  accompanying  result,  it  was  probably  be- 
cause I did  not  get  equal  pressure  upon  both  sides,  but  when  I adopted  this 
“straddling  movement”  it  brought  equal  pressure  on  both  sides,  then  I could 
get  that  sound  and  the  good  effect  following  the  replacement  of  the  parts  in 
that  way. 

I might  call  your  attention  to  the  technique  of  stretching  some  of  these 
scapular  muscles.  You  will,  in  your  treatment  of  the  upjier  part  of  the 
spine,  either  to  reduce  contractures  or  to  loosen  the  muscles  along  the  spine, 
find  that  you  must  stretch  these  scapular  muscles.  It  is  a good  plan  to  i^nsh 
the  patient’s  arm  well  down  to  the  side  on  a level  with  the  table,  then,  put- 
ting the  hand  beneath  the  scapula  until  the  fingers  are  overlapping  the  spinal 
edge  of  the  scapula;  the  shoulder  blade  has  been  approximated  to  the  spine, 
there  is  not  much  space  between  the  spine  and  the  edge  of  the  scajiula.  By 
holding  hrmly  you  can  stretch  that  part  of  the  muscles,  so  that  by  bringing 
the  arm  across  the  chest  you  bring  a stretching  motion  upon  the  scapulai' 
muscles.  By  use  of  the  thumb  on  the  scaleni  muscles  at  the  side  of  the  neck, 
bringing  the  arm  up  over  the  head,  with  your  thumb  over  those  muscles  you 
can  loosen  them,  this  being  a prei^aratory  step  to  the  setting  of  the  first  and 
second  ribs.  You  must  have  those  muscles  relaxed,  and  you  get  the  effect  in 
this  way  as  well.  Just  hold  them  with  one  hand  while  you  push  the  elbow 
up  toward  the  head  and  aronnd  toward  the  body.  Those  are  motions  fre- 
quently einjiloyed  in  practice. 

There  is  a question  now  as  to  how  to  reach  the  psoas  muscle.  It  is  one 
of  the  flexor  muscles  of  the  thigh.  It  is  a good  plan  to  simply  straighten  the 
legs  out  and  then  bow  the  back  inward  at  the  lumbar  region;  that  gives  it 
some  little  stretch  and  gets  considerable  of  an  effect  upon  the  psoas  muscle. 
The  lumbar  plexus  is  formed  in  the  substance  of  the  psoas  muscle,  and  if  it 
is  contracted  you  may  have  trouble  with  that  plexus.  I want  to  show  you 


64 


oue  other  motion  which  it  is  sometimes  necessary  to  use,  though  with  great 
moderation.  I show  is  to  you  i^rincipally  to  warn  you  against  its  use.  The 
patient  lies  on  his  face  and  you  lift  the  legs  from  the  table  and  then  work  from 
side  to  side;  you  can  thus  stretch  the  psoas  muscle  often  more  than  you  did 
before;  and  by  working  upward  along  the  spine,  one  operator  places  his  hand 
on  one  side  of  the  vertebra,  the  other  on  the  other;  you  can  thus  bring  press- 
sure  against  either  side  of  the  vertebrsn.  This  is  the  treatment  called  “break- 
ing up  the  spine.”  It  is  frequently  used  with  very  good  effect  in  cases  of 
diarrhoea,  flux  and  other  troubles.  The  warning  is  that  you  should  not  raise 
the  knees  high  above  the  table;  if  you  do  that  and  bow  the  back  too  much 
you  may  have  serious  results,  and  the  Old  Doctor  has  cautioned  us  against 
any  such  performance,  so  you  must  be  extremely  careful,  though  the  motion 
is  useful  in  reaching  certain  troubles.  You  might  not  only  strain  the  spine 
and  the  anterior  ligaments,  but  you  might  tip  the  parts  of  the  pelvis.  Dr. 
McConnell  spoke  of  a case  which  had  been  injured  in  that  way,  and  which 
has  been  serious  ever  since;  he  said  he  had  found  that  the  innominate  bones 
had  been  slipped,  and  that  there  was  an  inequality  at  the  S3nnphasis  of  the 
ndbes. 


LECTURE  XII. 


I wish  to  recapitulate  a little  in  regard  to  the  llth  lecture.  At  that  time  I 
brought  up  the  theory  of  work  upon  a spine  through  the  effect  we  could  get 
by  removing  lesions  in  the  shape  of  contracture  of  muscles.  I referred  to  Dr. 
Hart’s  theory,  which  was  a good  one ; his  idea  being  that  the  contracture  of 
muscles  shut  off  the  blood  suppl}'  in  the  muscular  branches  of  the  arteries,  and 
the  overplus  is  thus  thrown  to  the  cord  and  affects  centers  and  nerves,  stimu- 
lating at  first,  but  afterwards  leading  to  inhibition.  I explained  how  his  view 
led  up  to  that  result.  I then  went  farther  and  endeavored  to  show  that  such  a 
process  must  necessarily  be  by  affecting  vaso-motor  nerves,  otherwise  the  blood 
would  not  be  retained  about  the  centers  of  the  cord  to  influence  them.  And 
further,  that  we  might  have  an  effect  not  merely  upon  the  vaso-motor  nerves 
and  their  centers,  but  we  might  have  an  effect  directly  through  the  terminal 
sensorj"  branches,  running  from  the  muscles,  upon  sympathetic  and  internal 
life.  I then  brought  merely  to  your  notice,  without  attempting  to  prove  it,  the 
point  that  possibly  the  amount  of  blood  in  a part  would  account  for  certain 
nervous  effects.  Then  again  the  theory  of  Byron  Robinson,  that  the  pumping 
of  the  blood  from  the  heart  into  the  aorta  may  set  up  a reflex  action.  And 
finally,  the  quotation  from  Green’s  Pathology  that  there  was  always  a reflex  ar- 
rangement of  the  circulation,  that  if  the  superficial  vessels  were  dilated,  the 
deep  vessels  were  contracted,  and  vice  versa ; and  from  these  and  other  facts  it 


G5 


seemed  probable  that  we,  by  working  raechauically,  as  for  instance  pumping 
blood  into  the  limb,  bring  a certain  quantity  of  blood  to  act  upon  nerves,  we 
could  influence  nerves  and  centers.  However,  as  I said,  the  theory  is  a little 
hard  to  prove. 

I.  Theory  of  Osteopathic  Work  Upon  Nerve  Centers.  ■ (Continued.) 
— I wish  to  continue  the  same  general  subject  to-day,  going  a little  further  into 
the  question  of  contractures;  their  occurrence,  nature  and  cause.  Now,  as  to 
the  occurrence  of  contractures  along  the  spine  and  in  other  parts  of  the  bodv, 
their  importance  I think  was  fully  brought  out  in  the  last  lecture,  in  showing 
you  how  important  they  become  when  considered  as  lesions  along  the  spine,  es- 
pecially from  an  Osteopathic  standpoint.  We,  as  Osteopaths,  find  a great  deal 
to  say  about  contracted  muscles,  and  1 think  we  are  backed  by  the  authorities 
when  we  are  talking  about  them.  When  we  get  out  in  practice  and  tell  a 
patient  that  there  is  a muscle  in  his  back  or  neck  which  has  become  contracted 
and  failed  to  let  go,  he  is  sometimes  inclined  laOt  to  believe  it,  because  the  pop- 
ular idea  is  that  a muscle  contracts  and  lets  go  when  you  wish  it  to,  and  that  it 
simply  connot  couti’act  and  hold  on.  You  will  also  find  that  when  you  get  out 
among  the  medical  fraternity  they  will  try  to  pick  flaws  m your  argument,  and 
unless  you  are  backed  up  by  authority,  you  hardly  feel  so  strong  in  argument 
as  you  otherwise  would.  Hence,  I have  taken  up  this  question  a little  further 
to  show  that  what  are  termed  “contractures”  are  recognized  by  the  different 
authorities.  Howell’s  Text  Book  says:  “A  contracture  is  a state  of  continued 

contraction  of  a muscle.”  Gower  on  the  Nervous  Sj'stem  says:  “Tonic  spasms 
persistent  and  involving  only  a certain  group  of  muscles  causes  distorsion  of 
the  parts  to  which  they  are  attached,  and  is  termed  a contracture.”  In  the 
Journal  article  which  I quoted  at  the  last  lecture  a quotation  is  made  from  Dr. 
Allen’s  work  on  human  anatomy,  which  is  as  follows  : “An  abnormal  phase 

of  tonicity  is  met  with  when  a muscle  sustains  unduly  prolonged  action  of  its 
libers ; under  these  circumstances  a shortening  of  its  bell}'  takes  place,  which 
persists  as  long  as  the  cause  of  the  contraction  is  maintained.  Such  abnormal 
modification  of  contraction  is  termed  contracture.  Stretching  of  a coutraet- 
ured  muscle  is  readily  accomplished  and  maintained,  provided  the  cause  for 
the  contracture  is  removed.  Contracture,  clinically  considered,  is  a subject  of 
great  importance.  In  lateral  curvature  of  the  spine  contracture  of  muscles  will 
take  place  on  the  side  of  least  curvature.”  Hence,  you  see  that  the  authorities 
.agree  ; they  say  that  contractures  are  of  considerable  clinical  importance ; they 
say  that  they  cause  distortion  of  parts  to  which  they  are  attached.  Hence, 
you  see  that  others  besides  Osteopaths  attach  significance  to  this  congested 
condition  of  the  muscle  which  w'e  call  contracture.  But  it  is  important,  per- 
haps, in  taking  up  this  subject,  to  show  that  the  Oteopath,  in  work  upon  con- 
tractures, in  treating  them  as  lesions  and  in  removeing  them,  is  throughly  scien- 
tific and  has  the  weight  of  authority  and  science  behind  him.  There  is  a ques- 


G6 


tion  as  to  what  the  nature  of  a contracture  is.  We  saw  from  the  quotation 
above  that  Gower  understood  it  to  be  tonic  spasms;  then  Howell’s  Text  Book 
says  that  continuous  contractions  may  be  caused  by  continuous  excitation,  and 
it  regards  it  as  a tetamis.  Such  a condition  of  a muscle  may  be  found  also  in 
involuntary  muscles.  When  you  are  in  practice  you  will  find  that  frequently  in 
your  work  upon  the  intestines  that  they  are  drawn  and  hardened ; you  will  find 
the  stomach  hardened  to  the  touch,  and  this  is  an  abnormal  tonicity  which  is 
regarded  in  the  same  light  as  contractures,  although  that  term  is  not  applied  to 
it.  You  will  get  so  that  you  will  recognize  by  touch  the  normal  feeling  of  the 
abdomen,  and  hence  will  be  able  to  recognize  any  departure  from  the  normal. 
Kirk  is  authority  for  the  following  statement:  “Though  involuntary  muscle  can- 
not be  thrown  into  tetanus,  it  has  the  property  of  entering  into  a condition  of 
sustained  contraction,  called  tonus.”  Which  is,  as  far  as  our  purpose  goes, 
practically  the  same  thing.  You  will  find  in  your  work  that  there  is  quite  a 
difference  between  the  feeling  that  you  will  get  from  contracted  muscles  in  the 
back  and  the  feeling  that  you  get  when  working  upon  the  abdomen.  Now,  the 
external  musles  of  the  abdominal  wall  may  be  contracted  as  well  as  those  inter- 
nal musles,  and  you  will  find  often  the  outer  covering  of  the  abdomen  much 
contracted  and  hardened.  As  I said,  you  will  have  to  learn  by  experience 
what  is  the  natural  feeling  of  the  muscles  in  the  back  and  muscles  in  the  ab- 
domen, and  how  they  have  departed  from  that  by  becoming  contracted.  Then, 
again,  the  question  comes,  “Is  it  not  exercise  that  makes  these  muscles  hard, 
particularly  in  the  back?”  Therefore,  how  can  the  Osteopath  recognize  the 
difference  between  the  normal  hardening  of  a muscle  due  to  exercise,  and  a 
contraction  of  the  muscle  which  is  called  a contracture?  There  are  various 
ways,  some  of  which  I shall  give  you  later  in  the  lecture,  but  one  way  is  that 
when  a muscle  is  hardened  by  proper  exercise  it  is  homogeuiously  hardened, 
the  same  degree  of  hardness  all  over  it ; while  when  you  come  to  feel  of  a mus- 
cle which  IS  contracted,  you  are  apt  to  find  it  raised  in  welts.  We  shall  find 
the  reason  for  that  presently.  Of  course  there  is  a contracture  which,  accord- 
ing to  the  definition,  would  be  called  contracture,  but  different  from  what  I 
have  been  describing.  That  is  in  set  limbs  in  rheumatism,  and  things  of  that 
kind,  but  you  will  recognize  those  readily  by  the  case  itself. 

Now,  we  usually  find  these  contracted  muscles  not  only  in  the  back  and 
abdomen,  but  we  find  them  frequently  in  the  neck,  and  that  is  one  important 
place  that  you  will  have  to  watch  for  hardening  of  muscles.  The  explanation 
of  the  contracted  muscle  rising  m welts  on  the  back:  When  you  work  upon  the 
back  you  will  find  that  parts  of  muscle  slip  under  your  fingers,  as  if  you  were 
working  over  a whip  cord  or  something  hard  ; that  is  what  is  called  a welt. 
You  will,  of  course  find  muscles  normally  contracted  to  produce  motion.  I 
take  the  following  quotation  from  Gower,  which  will  explain  itself.  “Every 
movement  is  due  to  a contraction  of  a series  of  fibres,  vvhich  seldom  corre- 


spends  to  the  series  massed  together  in  a muscle.”  That  is,  you  frequently 
have  a contraction  ot  different  fibres,  you  might  say  a sort  of  a wave  of  con- 
traction running  through  different  fibres  of  different  muscles  to  produce  com- 
plex movement,  and  he  says  that  it  is  seldom  that  these  movements  are  massed 
together  in  a muscle.  Of  course  there  are  prominent  exceptions  to  the  rule, 
one  being  that  of  the  biceps.  He  goes  on  to  say : “Fibx'es,  not  muscles,  are 

represented  in  the  structure  of  the  brain,  and  those  that  cause  a simple  move- 
ment may  be  in  several  muscles.”  Hence,  you  see  that  a derangement  of  a 
certain  part  of  the  motor  area  in  the  cerebrum  may  cause  a lesion  of  parts  of 
several  muscles,  or  a lesion  of  different  nerve  fibres  of  the  muscles  may  cause 
a contraction  of  parts  of  different  muscles.  Howell’s  Text  Book  states:  “If 

the  muscle  be  in  an  abnormal  state  the  contraction  may  remain  localized  as  a 
swelling  or  welt.”  That  is  the  term  by  which  we  usually  describe  those  con- 
tractions. 

The  Osteopath  is  sure  of  his  grounds  scientifically  when  he  says  to  a pa- 
tient that  the  muscle  has  contracted  and  has  failed  to  relax.  When  he  finds 
that  such  a condition  is  present  it  is  a basis  of  work  on  his  part,  to  be  treated 
as  a lesion,  and  when  be  describes  it  as  a w^elt,  he  is  in  accord  with  the  au- 
thorities. 

The  question  naturally  comes,  “What  is  the  cause  ot  these  contractures?” 
The  Osteopath  regards  them  as  peculiarly  significant  from  his  standpoint.  We 
noted,  in  quoting  from  Howell’s  Text  Book  that  he  said  constant  irritation  pro- 
duced constant  contraction,  so  it  must  be  some  irritation  which  is  continually 
acting  upon  the  muscle  itself  or  upon  its  nerve  connection,  causing  it  to  act  in 
this  way.  That  of  course  would  lead  you  to  inquire  if  the  irritation  came  through 
the  sym])athetics.  You  will  find  some  of  the  visceral  diseases  sending  a con- 
tinuous impulse  over  the  sympathetics  through  the  spinal  nerves  to  the  mus- 
cles of  the  back.  Dr.  Billroth,  in  the  article  quoted  from  the  Journal,  states : 
“Contracture  of  muscle,  is  due  to  disease  of  the  muscles,  to  primary  disease  of 
the  nervous  system,  to  loss  of  antagonism,  as  well  as  to  excessive  use  of  one 
set  of  muscles  over  another.”  Gowers,  in  speaking  of  nerves  and  muscles 
says:  “The  excitability  is  changed  by  disease,  of  which  the  change  is  often  an 
important  symptom.”  (That  is,  the  change  in  a muscle  or  nerve  is  frequently 
an  important  symptom  of  disease.)  “It  indicates  the  seat  of  nutrition  of  the 
nerve  fibres  and  muscles,  and  from  this  we  can  draw  important  inferences  re- 
garding the  condition  of  the  centers.”  Gowers  states  that  paralysis  or  abnor- 
mal excitability  of  a nerve  refers  back  to  the  nerve  center  controlling  it.  If 
the  abnormal  excitability  has  been  such  as  to  result  in  contraction,  it  will  refer 
us  back  to  the  point  from  which  the  ii’ritation  came,  it  may  be  the  distant 
center  or  distant  periphery  of  some  other  set  of  nerves  reflected  back  sympa- 
thetically. 

In  discussing  before  you  previously  to  this  the  Osteopathic  view  of  con- 


68 


tracted  muscles,  I said  that  the  Osteopath  regarded  them  in  one  ease  as  prima- 
ry and  in  another  case  secondary.  Primarily,  yon  might  say,  is  where  a mus- 
cle IS  directly  acted  upon  by  some  external  force,  some  blow,  strain  or  draught 
of  cold  air,  causing  it  to  contract.  Your  contraction  then  is  your  primaiy 
lesion.  It  will  impinge  upon  the  nerve  fibres,  as  we  saw  a few  days  ago  in 
quotations  from  one  of  the  authorities,  that  the  terminal  sensory  fibres  of  the 
of  the  muscles  are  irritated  by  contractures,  and  that  constant  irritation  may  be 
set  up  and  carried  into  the  system  anywhere,  according  to  the  centers  affected. 
This,  then,  would  be  a primary  lesion.  A secondaiy  lesion  would  be  one  of 
the  kind  described  a few  minutes  since,  when  I noted  the  fact  that  we  might 
have  stomach  trouble  producing  secondarily  a lesion  of  the  muscles  of  the  back 
producing  welts  ; so-called  contractures.  When  the  lesion  is  primary,  of  course 
tl>at  indicates  at  once  to  us  where  the  trouble  is.  and  you,  as  Osteopaths,  have 
learned  by  this  time  that  you  must  go  to  the  seat  of  the  trouble ; even  though 
you  have  to  trace  it  a long  way  back,  you  will  finally  come  to  it.  So  that  when 
you  have  the  contracture  acting  as  a primary  cause  of  disease  from  its  nervous 
connections,  then  of  course  by  removing  the  contracture,  you  have  removed 
that  which  is  irritating  or  inhibiting.  You  have  restored  the  normal,  and  al- 
lowed nature  to  take  care  of  the  balance.  When  it  is  secondary,  it  is  a symp- 
tom, as  Gowers  says,  of  a diseased  condition  of  a center;  it  may  be,  and  so 
the  Osteopath  treats  it.  In  case  the  diseased  stomach  has  caused  a contracture 
in  the  back,  we  could  not  say  that  by  removing  that  lesion  we  have  removed 
the  primary  cause  itself.  But  the  value  of  that  to  the  Osteopath  is,  that  he 
thereby  sees  where  the  trouble  is ; it  is  to  him  a symptom,  and  he  can  trace  it 
back,  and  aided  by  other  symptoms,  find  the  original  cause.  Not  only  that, 
but,  according  to  what  we  have  learned  previously,  the  effect  that  the  Osteo- 
path can  have  by  working  through  nerve  terminals  may  be  gotten.  He  can 
work  npon  these  lesions,  which  are  secondary,  and  remove  them,  and  he  can 
thus  affect  the  peripheral  terminations.  Now,  if  the  cause  works  backwards 
over  these  nerves,  then  his  woi’k  can  reach  forward  along  the  same  track,  and 
he  can  get  an  effect  upon  the  original  seat  of  the  disease.  He  can  stimulate 
the  stomach,  in  other  words,  by  working  along  the  back  in  the  region  of  the 
splanchnics.  Of  course  he  would  combine  work  upon  the  secondary  lesion 
with  work  upon  the  original  cause  of  the  disease,  whatever  it  was,  and  his  good 
judgment  and  ability  to  diagnose  would  have  to  tell  him  when  the  lesion  was 
primarv  or  secondary.  I recollect  a case  of  cholera  which  we  treated  at  one 
time  in  Evanston,  which  had  been  of  seven  years’  standing.  It  was  the  case 
of  a young  lady  who  was  some  twenty  years  of  age,  and  it  was  very  bad  when 
brought  to  us.  She  tossed  about  and  nearly  threw  herself  from  the  table,  and 
it  required  one  to  hold  while  one  treated.  The  lesion  in  that  case  we  found 
mostly  along  the  back  on  the  left  side  of  the  spine;  the  muscles  were  in  a con- 
tracted condition  all  along  that  side  of  the  spine.  We  also  found  that  the 


69 


muscles  iu  the  neck  were  quite  stiff;  we  were  x^articular  to  remove  that  con- 
gested condition  of  the  muscles,  and  the  cure  was  complete  although  the  case 
had  been  of  seven  years’  standing.  It  was  quite  a satisfactory  case.  Xow, 
the  question  is,  whether  that  w'as  a primary  lesion  or  a secondary,  and  it  is 
very  hard  to  say.  The  causes  of  cholera  are  external  sometimes — rheumatism 
or  exposure — and  in  such  a case  the  lesion  may  have  been  primary,  the  effect 
of  exposttre  or  rheimialism  may  have  hardened  the  muscles  in  the  hack.  In 
other  cases  it  is  due  to  over-work,  worry  and  a whole  list  of  different  causes. 
So  it  may  have  acted  indirectly,  and  thus  have  produced  those  contractures. 
By  working  there  we  remove  that  lesion,  whether  it  was  primary  or  seeodary, 
and  we  get  our  results.  Of  course  we  used  general  treatment  with  the  special 
treatment  which  we  gave  to  the  lesions.  My  chief  xmrpose  in  following  this 
line  of  thought  was  to  show  that  the  Osteopath  in  talking  about  contractures, 
in  treating  them  as  lesions,  and  in  working  directly  upon  them  as  such,  is 
thoroughly  scientific.  As  I showed  you  in  previous  lectures,  he  can  work  upon 
nerve  terminals  in  these  muscles  and  thus  gain  important  results.  And  I think 
that  an  Osteopath  in  an  argument  with  a physician  ought  not  to  come  out  sec- 
ond best. 

There  is  one  further  point  which  I want  to  bring  out;  and  that  is  the  fact 
that  you  will  find  flabby  muscles,  and  when  a muscle  has  become  flabby  it  is 
usually  an  indication  that  the  disease  has  jirogressed  to  a considerable  de- 
gree. Very  frequently  these  muscles  have  lost  their  tone,  and  our  mode  of 
reasoning  is  that  we  must  restore  life  to  them.  I wish  to  state  what  Gowers 
has  said  in  this  regard.  He  says:  “That  when  a muscle  is  thus  flabby,  it 

shows  some  lesion  of  the  nerve  fibers  controlling  the  muscle.  And  pathology’ 
has  shown  that  section  of  a motor  nerve  of  a muscle  will  lead  to  deterioration 
in  the  condition  of  the  muscle.  Hence,  there  is  close  trophic  connection  be- 
tween the  nerves  and  the  muscle  fibers,  so  that,  reasoning  from  that,  when 
you  find  a flabby  condition  of  a muscle,  you  must  have  a diseased  condition 
wliich  has  advanced  considerably. 

In  lu’evious  lectures  I have  considered  fully  the  spine,  first:  How  to  ex- 

amine it;  second,  how  to  consider  the  lesions  found,  that  is,  their  significance: 
and  third,  how  to  treat  your  lesions  when  found.  I know  of  no  other  jjoints 
which  I should  bring  up  in  that  connection.  I shall,  therefore,  go  to  the 
neck,  and  tell  you  of  its  indications. 

II.  Landmarks  Concbrninc^  the  Xeck: — First,  as  Holden  says,  we 
note  a great  difference  between  the  skin  on  the  back  of  the  neck,  where  it  is 
very  thick,  and  that  on  the  front  of  the  neck,  which  is  extremely  thin:  this  is 
the  best  place  in  the  body  to  note  that  difference.  The  exteimal  jugular  vein 
corresponds  with  a line  drawn  from  the  angle  of  the  inferior  maxillary  bone 
bone  to  a x^oint  at  the  middle  of  the  clavical.  We  find  in  certain  heart  trou- 
bles a venous' x>ulse  can  be  detected  in  that  vein,  we  can  see  it  from  a distance. 


70 


There  is  a case  in  to’n-n  in  which  the  venous  pulse  can  be  seen  in  the  jugular 
vein.  There  is  also  a venous  hum  in  that  vein  in  anemia. 

The  hyoid  bone  is  on  a level  with  the  lower  jaw;  the  gai)  just  below  it 
corresponds  to  the  apex  of  the  epiglottis;  therefore  any  deep  cut  at  that  point 
leaves  almost  the  whole  of  the  glottis  above  the  cut.  The  thyroid  cartilege 
is  familiar  to  you  all,  and  you  can  by  feeling  carefnlly  trace  out  both  the  uj>- 
per  and  lower  cornua.  The  lateral  lobes  of  the  thyroid  gland  lie  on  each  side 
of  the  thyroid  cartilege;  the  bridge  lies  across  the  middle,  and  in  that  region 
you  can  feel  the  pulsation  of  the  superior  thyroid  artery.  The  crico-thyroid 
membrane,  as  you  know,  joins  the  thyroid  and  cricoid  cartileges,  and  that  is 
the  point  at  which  laryngotomy  is  j)erformed.  The  level  of  the  cricoid  carti- 
lege corresponds  to  the  interval  between  the  fifth  and  sixth  cervical  vertebrae; 
it  is  also  the  level  of  the  oesophagus.  Hence,  if  a child  has  attempted  to 
swallow  something  too  large  for  it,  it  will  probably  be  lodged  in  that  place. 
The  superior  opening  of  the  oesophagus  is  usually  an  inch  and  a half  above 
the  sternum,  but  it  may  get  as  far  as  two  and  a fourth  inches  above  the 
sternum,  formally  about  seven  or  eight  rings  of  the  trachea  protrude  above 
the  sternum,  but  they  are  not  felt  from  the  outside,  being  covered  by  other 
structures.  Surgical  operations  are  conducted  in  the  middle  line  of  the  neck, 
which  is  called  the  “line  of  safety.” 

III.  How  TO  Examine  the  Xeck: — Of  course  you  all  know  that  there 
is  nothing  of  greater  importance  to  the  Osteopath  in  the  body  than  the  neck. 
Dr.  Harry  Still  is  authority  for  the  statement  that  almost  all  diseases  of  the 
body  can  be  treated  through  the  neck.  Of  course  that  is  jiuttiug  it  very 
broadly,  but  it  is  very  expressive.  You  can  treat  in  the  neck  alone  and  ef- 
fect the  stomach,  heart,  liver  or  intestines  and  you  can  treat,  of  course,  in 
the  neck  and  affect  the  brain,  or  affect  the  vaso  motor  life  for  the  whole  body. 

In  the  examination  of  the  neck  I have  divided  the  subject  into  first,  the 
throat.  You  all  know  where  to  find  the  tonsil  just  beneath  the  angle  of  the 
inferior  maxillary  bone;  it  is  very  readily  felt  when  you  want  to  find  it,  in 
cases  of  tonsilitis  it  is  easily  found.  If  you  cannot  find  it  on  the  outside,  you 
can  examine  inside  in  the  throat.  So  in  examination  of  the  throat  you  must 
always  look  for  the  tonsils  if  you  suspicion  tonsilitis.  You  must  look  for 
tender  iioints  about  the  throat,  and  where  we  frequently  find  them  is,  in  case 
of  catarrh,  just  below  the  angle  of  the  jaw.  It  is  said  that  in  every  case  of 
catarrh  there  is  a tender  point  just  below  the  angle  of  the  jaw.  I will  not 
vouch  for  the  statement,  but  it  is  made  on  good  authority'.  Further,  in  ex- 
amination of  the  throat,  always  look  to  see  what  is  the  condition  of  the  hyoid 
muscles.  They  are  of  great  importance  to  the  Osteopath — those  above  the 
hyoid  bone  and  those  below  it;  either  or  both  may  be  contracted,  congested, 
or  drawn,  shutting  off  the  blood  supiily  to  the  other  parts  of  the  head  or  the 
throat,  causing  very  numerous  troubles.  Of  course  you  must  always  examine 


71 


your  patient  to  see  tliat  all  parts  are  normal.  You  slioiild  direct  your  atten- 
tion first  to  the  hyoid  bone,  then  to  the  thyroid  and  cricoid  cartileges,  not  be- 
cause we  find  them  of  great  Osteopathic  significance,  but  to  see  that  every- 
thing is  normal.  Of  course,  in  order  to  recognize  the  abnormal  you  must  ac- 
quaint yourselves  with  the  normal.  The  thyroid  gland  itself  has  been  de- 
sei’ibed.  You  should  bear  in  mind  that  it  may  be  enlarged  in  disease,  as  in 
goitre,  or  it  may  be  atrophied,  as  in  myxedema.  You  will  be  able  to  find  it 
very  readily,  and  you  must  decide  whether  it  is  enlarged  or  wasted,  and 
therefore,  you  must  know  what  is  its  normal  size. 

You  will  frequently  find  that  the  lymphatics  are  enlarged  in  the  neck; 
the  kernels  found  along  the  course  of  the  veins  in  the  neck.  The  lymphatic 
glands  sometimes  become  enlarged,  and  remain  so  for  years,  showing  that 
there  is  some  irritation  or  some  septic  process  still  going  on.  In  ijeojjle  with 
chronic  sore  throats  we  will  frequently  find  that  the  lymphatic  glands  are  en- 
larged, sometimes  they  are  left  so  by  diphtheria,  or  any  disease  which  leaves 
in  the  system  a septic  product,  which  of  course  is  taken  up  by  the  lymphatics. 
So  you  must  look  to  see  whether  or  not  the  lymphatics  are  enlarged.  If  they 
are,  of  course  the  treatment  is  not  to  them,  but  is  to  remove  the  cause  of  the 
disease. 

A further  point  as  to  the  anatomy  of  the  neck  in  connection  with  Osteo- 
pathy: you  will  find  that  the  glossopharyngeal,  pneumogastric  and  spinal  ac- 
cessory nerves  leave  the  skull  through  the  jugular  foramen.  The  pneumo- 
gastrie  runs  on  down  just  behind  the  anterior  border  of  the  sterno-mastoid 
muscle,  and  we  work  upon  it  as  we  work  along  the  muscles  in  that  way. 
Frequently  we  work  upon  it  high  up  at  its  exit  from  the  skull,  that  is,  as  near 
as  we  can  get  to  it.  We  can  usually  bring  pressure  upon  the  nerves  at  that 
point.  Frequently,  also,  we  work  upon  these  nerves  through  their  sympa- 
thetic connection  with  the  superior  cervical  ganglion. 

The  phrenic  nerve,  as  you  know,  springs  from  the  3d,  4th  and  5th  cervi- 
cal nerves,  and  you  reach  it  at  the  anterior  border  of  the  scaleni  muscles, 
right  along  the  edge  of  the  transverse  processes  of  the  vertebrae.  You  can 
impinge  upon  the  nerve  in  that  region,  and  you  can  also  find  the  nerve,  or  get 
an  effect  upon  the  nerve  by  pressure  between  the  sternal  and  clavicular  origins 
of  the  sterno-mastoid  muscle.  That  is  where  the  treatment  is  usually  given 
in  case  of  hiccoughs. 


LECTURE  XIII. 


At  the  last  lecture  under  the  general  head  of  theory  of  work  upoa  centers, 
I considered  contractures,  their  occurrence,  nature  and  cause.  I explained, 
according  to  the  authorities,  how  these  contractures  happened,  and  that  this 


was  the  scientific  definition,  the  term  meaning  continued  contraction.  I quoted 
from  Gowers,  Howell’s  Text  Book,  and  others,  to  substantiate  the  point.  I 
called  to  your  mind  the  clinical  importance  that  is  attached  to  these  conditions, 
especially  by  the  Osteopath.  I called  to  your  mind  their  nature,  that  is,  that 
they  are  called  a tonic  spasm,  being  considered  in  the  nature  of  a tetanus;  also 
the  fact  that  the  continued  tonicity  of  the  involuntary  muscles  might  exist, 
which  for  our  purpose  is  practically  a contracture,  although  not  called  so.  I 
called  your  attention  to  how  you  might  recognize  the  difference  between  these 
conditions  by  the  touefi.  The  chief  points  where  these  occur  are  in  the  neck, 
back  and  abdomen,  as  well  as  the  limbs  in  some  cases.  I called  to  your  atten- 
tion the  fact  that  muscles  normally  contract  not  as  a whole  usually,  but  as  sep- 
arate fibres  of  several  muscles,  according  to  Gowers’  authority,  and  that  ac- 
counts for  the  appearance  of  welts ; the  feeling  of  welts  under  the  fingers.  That 
the  cause  was  some  constant  irritation,  some  direct  injurv  to  the  muscle,  or 
some  exposure,  or  something  of  that  kind.  That  is,  that  the  contracture  might 
be  primary,  as  in  the  case  of  a blow  or  injury;  and  secondary  when  a muscle 
contracts  due  to  a trouble  which  is  far  removed,  as  for  instance  muscles  over 
the  splanchnics  contracted  secondarily  to  the  affection  in  the  stomach.  I noted 
that  muscles  which  felt  flabby  were  a sign  that  the  disease  had  probably  pro- 
gressed for  some  time,  and  that  the  centers  and  nerves  were  affected.  I also 
called  your  attention  to  certain  landmarks  in  the  neck.  To-day  I wish  to  con- 
sider the  same  general  subject  further. 

I.  Theory  op  Osteopathic  Work  Upon  the  Ner\t:  Centers,  Under 
THE  Special  Head  op  Further  Possible  Lesions. 

I have  explained  to  you  the  nature  of  some  lesions,  at  the  last  meeting  the 
nature  of  a lesion  when  it  is  a contracture.  I have  also  called  to  your  mind 
other  lesions,  such  as  a slip  of  the  vertebree,  a displacement  of  apart,  bringing 
pressure  upon  a blood  vessel  or  upon  a nerve.  I believe  I mentioned  tumors  at 
one  lecture,  but  I shall  carry  that  idea  further  at  some  time.  Also  I mentioned 
the  lack  of  normal  blood-supply  being  anemia,  or  perhaps  too  much  blood,  be- 
ing hyperemia.  So  that  we  have  already  considered  certain  lesions  which  may 
affect  the  body,  may  act  through  the  nerve  and  cause  disease.  A further  very 
important  lesion  which  we  frequently  find  in  our  work  is  a thickening  of  liga- 
ments following  a strain  or  some  injury.  Pathology  teaches  us  that  after  hav- 
ing irritation  we  frequently  have  an  inflammation.  That  means  that  too  much 
blood  is  circulated  about  the  part,  and  in  the  natural  process  of  inflammation  an 
an  exudation  follows,  first  fluid,  latter  cellular,  of  both  kinds  of  corpuscles. 
When  this  state  of  inflammation  has  gone  far  enough  you  have  resulting  a new 
growth.  We  know  that  this  new  growth  is  connective  tissues  or  scar-tissues. 
It  is  well  seen  in  a disease  called  cirrhosis  of  the  liver,  usually  induced,  or 
sometimes  at  least,  by  the  drinking  of  alcohol.  The  alcoholic  poisoning  sets  up 
an  inflammation.  Following  this  inflammation  there  results  a growth  of  new 


connective  tissues,  the  connective  tissues  normally  occurring  throughout  the 
liver  are  thickened.  Now,  this  new  growth  of  connective  tissues  is  all  right  as 
it  is  new  and  fresh  and  filled  with  blood  vessles.  But  sooner  or  later  the  blood 
vessles  begin  to  be  contracted  and  absorbed  and  the  tissue  looses  its  blood 
supply  and  then  it  begins  to  contract  and  become  pale.  When  that  process  has 
gone  far  enough,  the  contraction  has  acted  mechanically  and  shut  down  upon 
the  blood  supply  passing  through  the  liver,  thus  the  portal  circulation  is  ob- 
structed, and  the  blood  sets  back  and  produces  what  is  known  as  ascites,  or 
dropsy  of  the  abdomen.  There  you  have  a thickening  of  the  connective  tissues, 
you  have  resulting  from  that  a condition  of  pressure,  a shutting  down  of  the 
thickened  tissues  upon  the  part  concerned.  In  sclerosis  of  the  spinal  cord 
you  have  a thickening  of  the  connective  tissue  either  at  the  expense  of,  or  fol- 
lowing, degeneration  of  the  nervous  elements  of  the  cord.  When  you  have  had 
a wound,  say  a cut  with  a knife,  you  have,  in  the  process  of  healing,  the  forma- 
tion of  what  is  technically  known  as  granulation  tissues,  this  is  followed  later 
by  the  appearance  of  blood  vessels  in  new  connective  tissue,  and  you  have  jmur 
scar.  iSo-called  scar  tissues  occur  not  only  after  cuts  and  wounds,  but  after 
abscesses  and  various  pathological  processes  in  the  body.  I wish  to  bring 
these  things  to  your  attention  for  the  purpose  of  showing  you  that  it  is  a con- 
stant and  very  general  pathological  tendency  in  the  body  to  produce  new  con- 
nective tissue,  and  it  is  the  tendency  of  that  connective  tissue  when  produced  to 
contract.  There  you  have  something  that  is  a very  frequent  source  of  disease, 
and  it  is  of  especial  interest  to  the  Osteopath,  from  his  point  of  view,  since  it 
means  that  there  rnaj’’  thereby  be  a mechanical  lesion,  a direct  shutting  doivn 
upon  the  parts.  You  have  all  known  of  cases  where  a scab  has  formed  upon 
some  external  sores,  catching  some  sensory  nerve  terminals  in  its  connective 
tissue,  as  it  becomes  old  and  commences  to  contract,  it  irritates  those  termina- 
tions of  nerves,  producing  constant  pain  in  the  part. 

I wish  to  quote  from  Green’s  Pathology,  where  he  says:  “The  new  con- 

nective tissue  is  called  inflammatory  or  scar  tissue.  The  tendency  to  contract 
is  characteristic  of  this  new  fibrous  tissue.”  This  contraction  of  scar  tissue 
may  produce  serious  results.”  You  will  readily  recognize  the  Osteopathic 
significance  of  anything  that  will  contract  and  obstruct  the  channels  of  blood 
or  nerve  force.  These  causes  are  especially  significant,  it  seems  to  me.  in 
relation  to  the  spine,  so  I have  considered  that  first.  Now,  what  may  the 
nature  of  your  lesion  be"?  As  I have  said  before,  it  might  be  a vertebra  dis- 
placed; it  may  be  twisted  or  slipped,  or  in  any  way  so  placed  as  to  bring  ir- 
ritation upon  the  parts  surrounding  it.  It  makes  no  practical  difference  for 
our  purpose  whether  first,  that  irritation  acts  upon  nerves  or  upon  blood 
vessels,  just  so  it  be  sufficient  to  act  upon  the  ligamentous  parts  about  the 
vertebrae  to  irritate  them.  You  will  then  have  an  inflammation.  Secondary 
to  this  irritation  you  may  not  have  inflammation,  but  hyperemia.  Following 


74 


tliis  iutiamnuitiou  you  would  naturally,  according  to  the  laws  of  disease,  have 
a thickening  of  the  connective  tissue.  I wish  again  to  quote  from  Green, 
speaking  about  inflammations,  and  under  the  head  of  injuries,  slight  but  long 
continued,  he  says:  “In  many  cases  the  inflammatory  process  ends  in  the 

formation  of  new  tissue — inflammatory  fibrous  tissue.”  You  will  notice 
there  that  the  injury  may  only  be  slight,  but  long  continued.  Such  is  the 
nature  of  a great  many  lesions  that  we  And  in  the  spine.  A man  comes  to 
the  Osteopath’s  offlce  for  examination.  He  says:  “You  have  had  a strain  or 
twist  here  in  the  spine  in  some  way.”  The  patient  says  he  never  had  any 
strain  or  twist  there.  The  Osteoi)ath  still  thinks  that  he  must  have  had  a 
strain  there.  The  reason  why  he  did  not  know  it  was  simi^ly  because  it  was 
so  slight  as  to  escape  observation,  and  has  not  been  attended  to  because 
slight,  and  therefore  has  been  long  continued,  and  finally  results  in  some  x)ro- 
cess  of  pathological  growth.  Further,  Green  says:  “If  the  hyperemia  be  of 

long  duration  or  frequently  repeated,  the  epithelium  and  connective  tissue  of 
the  part  increase.”  So  an  inflammation  is  not  always  necessary  to  produce 
thickening  of  the  connective  tissue,  but  it  may  occur  from  hyijeremia.  Too 
much  blood  about  a part  may,  according  to  Green,  either  cause  a thickening 
of  the  epithelium  or  of  the  connective  tissue.  So  your  lesion  which  has  pro- 
duced nerve  irritation  and  caused  inflammation,  may  be  slight,  or  on  the 
other  hand,  may  cause  hyperemia,  which  may  not  necessarily  be  known  to 
the  patient.  So  much,  then,  for  the  tendency  of  these  newly  formed  tissues 
to  contract  and  to  obstruct.  From  what  I have  already  said  you  will  see  the 
significance  of  these  things  from  our  standj^oint,  as  I have  already  exjjlained 
to  you  the  effect  of  thickening  of  tendons  or  hardening  of  muscles  or  liga- 
ments. 

Your  lesion  may  be  not  only  in  the  nature  of  some  sliiJ  or  twist  of  the 
vertebrae,  but,  secondly,  it  may  be  a strain,  a pull,  a cold  draft,  oi-  some- 
thing of  that  nature — external  violence.  You  are  all  familiar  with  the 
phenomena  which  follow  a spi'ained  ankle,  as  we  call  it,  and  you  have  i^rob- 
ably  often  heard  the  lihysician  say  that  such  an  injury  was  in  some  cases 
worse  than  a broken  bone.  You  have,  following  a strain,  an  inflammatory 
process,  and  you  have  following  that  inflammatory  ijrocess  of  course,  this 
thickening  of  the  connective  tissue.  Then,  again,  you  may  have  a lesion  in 
the  nature  of  bad  blood.  If  the  blood  is  not  jiure,  and  if  all  of  the  excretory 
organs  of  the  body  ai-e  not  doing  their  duty,  the  bad  blood  then  acts  as  an  ir- 
ritant and  may  inflame  i^arts.  Your  lesion  may,  fourthly,  be  in  the  nature  of 
some  exjjosure,  or  cold,  or  rheumatism.  Quain,  in  his  dictionary,  speaking 
of  disease  of  the  spine,  says:  “The  ligaments  here,  as  in  other  parts  of  the 

body,  are  esi)ecially  liable  to  a rheumatic  form  of  inflammation.”  Inflamma- 
tion means  to  us  the  formation  of  a new  growth;  a new  growth  very  j^robably 
means  the  formation  of  an  obstruction,  which  of  course  acts  as  a continual  ir- 


ritation  upon  the  part  affected,  with  all  the  concomitant  results.  In  view  of 
the  above  facts,  may  not  any  Osteopath  see  the  tremendous  significance  from 
his  standpoint  of  slight,  or  it  may  be  severe,  sprains,  slips,  twists,  subluxa- 
tions, injuries,  exposures,  and  the  like!  Can  he  fail  to  recognize  the  import- 
ance of  such  factors  in  the  causation  of  disease,  or  can  he  disregard  the 
therapeutic  value  of  their  removal"?  It  seems  that  when  we  look  at  these 
things  from  an  Osteopathic  standpoint,  they  become  fi’aught  with  great  signi- 
ficance, and  to  my  mind,  nothing  is  more  encouraging  to  an  Osteopath  than 
the  thought  that  he  can  go  about  to  remedy  these  pathological  results.  I have 
brought  this  up  because  it  seemed  to  me  that  these  were  properly  Osteojiathic 
points.  Hence,  you  will  note  the  importance  of  what  we  haA^e  already  said 
in  previous  lectures,  that  you  should  always  and  under  all  circumstances 
look  for  lesions.  You  should  always,  also,  inquire  into  the  history  of  the 
case. 

The  method  of  questioning  is  one  of  the  vahiable  means  by  which  we 
diagnose  the  case,  it  is  the  only  thing  that  leads  us  into  the  history  of  the 
case. 

These  lesions,  siich  as  described,  are  of  j^articular  imiAortance  to  the  Os- 
teopath because  you  know  that  a contraction  may  cause,  foi'  instance,  distor- 
tion of  a i^art,  as  we  frequently  find  in  our  practice.  YTieu  a part  has  left 
its  normal  position  it  may  very  likely  be  obstructing  some  of  the  fluids  of 
life,  or  ijressing  iipon  important  parts,  thus  producing  disease.  So  that  the 
result  of  the  lesions  may  not  only  be  distortions  but  may  be  obstruction  of 
parts;  and  further,  they  may  lead  to  ankylosis  or  ossification  of  the  iiarts. 
Quain’s  Dictionary  in  speaking  of  Pott’ s disease,  says:  “In  the  majority  of 

cases  sclerosis  of  one  or  more  intervertebral  cartileges  occurs  as  a result  of 
sub-acute  infiammatiou;  if  the  case  proceed  favorably  tOAvard  a curative  ter- 
mination, the  destructiA^e  process  becomes  arrested  and  a healthy  process  is 
re-established,  terminating  . in  bony  ankylosis  betAveen  the  bodies  of  the 
vertebrae;  ossification  also  spreads  along  some  of  the  ligamentous  structures 
passing  between  the  laminae,  as  well  as  betAveen  the  spinous  processes." 
“Thus,”  he  goes  on  to  say,  “the  resulting  .liosterior  protrusion  becomes  a 
persistant  deformity,  a deformity  essential  to  the  cure  of  the  disease.’'  Pott's 
disease,  I might  say,  is  the  extreme  posterior  curvature  of  the  spine,  also 
commonly  called  hunch  back.  ISIoav,  as  to  this  explanation,  there  are  seA’eral 
points  to  Avhich  I Avish  to  invite  your  attention.  In  the  first  place,  it  em- 
phasizes the  important  of  infiammation,  as  he  says  the  condition  may  result 
from  infiammatiou  between  the  bodies  of  the  vertebne.  Further,  that  that 
infiammation  may  be  the  result  of  some  rheumatic  ijrocess  started  in  the  liga- 
ments about  the  spine.  Second,  that  the  result  may  be  ankylosis  or  ossifica- 
tion, if  the  case  has  gone  far  enough.  Third,  to  the  Osteopath  it  is  difficult 
to  call  a deformity  a cure;  that  is  Avhat  we  call  disease;  patients  come  to  us 


witli  deformities  to  be  cured.  It  has  been  a matter  of  some  surprise  that  T 
noticed  that  not  only  Quain,  but  others,  for  instance,  Hilton,  speak  of  cure 
by  hxation  or  ossification  of  parts.  Xow,  I do  not  call  this  to  your  attention 
to  tell  you  that  you  can  cure  every  one  having  ossification  or  ankylosis  of  the 
vertebrae.  However,  there  is  a kind  of  ankylosis  that  may  be  cured  by  the 
Osteopath,  and  that  is  the  ligamentous  form.  When  it  has  reached  ossifica- 
tion, it  is  beyond  our  power,  ttliat  the  Osteopath  is  called  upon  to  do  in 
such  a ease,  where  there  is  fixation  of  ijarts  of  bony  growth,  is  to  give  relief 
or  perhaps  strengthen  the  general  condition  of  the  body,  which  he  can  very 
frequently  do.  The  peculiar  work  of  the  Osteopath,  in  cases  which  are  pro- 
ceeding to  such  a termination,  is  not  that  he  may  remove  the  ankylosis  or 
the  ossification,  but  that  he  may  prevent  its  forming.  I think  our  practice 
justifies  the  statement  that  he  can  prevent  such  things.  A great  many  cases 
of  spinal  curvature  have  been  cured  out-right,  and  there  is  no  telling  what 
the  termination  of  such  a case  of  spinal  curvature  may  be.  However,  they 
might  have  gone  on  to  ossification  or  ankylosis  of  the  joints.  The  simple 
facts  are  that  cases  of  deformiH  have  been  saved  from  being  parmanent,  and 
that  people  have  been  saved  from  the  lives  of  cripples  time  and  again  by  Os- 
teopathic therapeutics.  And  S3  these  things  are  significant  to  us  more  in  a 
prophylactic  light,  that  is,  that  we  may  prevent  their  growth. 

For  examples  of  the  general  cause  of  disease  following  a slip  or  strain, 
which  has  resulted  in  a thickening  of  ligaments.  T wish  to  note  several  cases: 
I have  had  cases  in  which,  along  the  region  of  the  splachnic  nerves,  there 
was  a tightening  of  all  the  ligaments,  the  parts  of  the  spine  being  approxi- 
mated. The  result  of  that  lesion  was  some  form  of  stomach  trouble.  I have 
seen  a case  of  neurasthenia,  which  I would  attribute  to  such  a cause,  ^yhen 
Ijracticing  in  Chicago  we  had  a gentleman  who  was  in  rather  a remarkable 
condition.  His  general  trouble  might  be  described  as  neurasthenia.  His 
trouble  was  largely  circulatory  and  nervous.  He  had  a skin  as  soft  as  a 
baby’s  almost;  a ruddy  complexion;  looked  strong  and  healthy,  and  one 
would  hardly  think  there  was  an;\Thing  wrong  with  him.  But  he  said  he 
would  at  almost  any  time  break  out  into  a i^erspiration,  when  there  was  not 
any  heat  at  all  or  exertion  to  account  foi-  it.  or  perhaj)S  he  would  be  chilly. 
Then,  agam.  he  would  flush  up  following  any  exertion.  He  would  have 
trouble  with  his  head,  and  could  not  work  at  times;  At  times  he  would  be 
bothered  with  sleeplessness.  Xow,  those  were  general  nervous  troubles  and 
troubles  of  the  circulation-  He  was  a man.  who,  on  account  of  his  disease, 
led  practically  an  outdoor  life.  The  lesion  in  his  case,  according  to  onr  ex- 
amination was  along  the  spine.  We  found  that  the  ligaments  along  the  spine 
seemed  to  be  tightened,  and  that  the  muscles  were  contracted.  Xow,  whether 
or  not  the  theory  fits  the  facts,  and  whether  or  not  all  these  things  are 
brought  out  properly,  it  seems  to  me  they  explain,  at  least  theoretically,  what 


we  do  when  we  meet  similar  cases  and  go  to  work  to  i-emove  such  lesions. 
Snch  lesions  then,  may  come,  first,  by  direct  impingement  and  irritation  of 
the  nerves.  As,  for  instance,  where  they  emerge  from  the  spine  at  the  inter- 
vertebral foramina.  Second,  they  may  act  through  the  blood  supply,  as  was 
shown  in  a lecture  or  two  since,  by  causing  anemia  or  h>-peremia  of  the  cen- 
ters or  the  nerves.  This  hyperemia  or  anemia  may  be  collateral  on  account 
of  the  condition  of  the  circulation  to  the  spinal  muscles,  or  the  anemia  may 
exist  directly  by  pressure  at  the  intervertebral  foramina  on  the  anterior  and 
posterior  spinal  branches,  or  perhaps  pressure  in  the  same  way  on  the 
vertebral  branches  of  the  arteries,  and  thus  shutting  off  of  the  blood  supjily 
to  the  cord. 

II.  Landmarks  ('oncerninC4  the  Neck  : — Holden  notes  the  sternomas- 
toid  muscles,  which  he  calls  the  surgical  land-mark  of  the  neck,  and  calls  to 
our  attention  the  fact  that  it  stands  out  in  relief  when  acting  to  turn  the  head 
toward  the  oposite  shoulder.  Behind  its  inner  border  lies  the  pneumo gastric 
nerve,  in  the  same  sheath  with  the  common  carotid  artery  and  the  internal 
jugular  vein.  The  common  carotid  artery  runs  as  far  as  the  upper  level  of  the 
thyriod  cartilage,  where  it  branches  into  the  internal  and  external  carotids ; its 
course  corresponds  to  a line  drawn  from  the  sterno-elavicular  articulation  to  a 
point  midway  between  the  angle  of  the  lower  jaw  and  the  mastoid  process. 
Note  the  interval  between  the  sternal  and  clavicular  origins  of  the  sterno-mas- 
toid  muscle.  Just  behind  this  interval  lies  the  common  carotid  artery  inter- 
nall}%  the  internal  jugular  vein  externally.  Between  them,  and  a little  poster- 
iorly, lies  the  pneumogastric  nerve.  The  sterno-clavicular  joint  is  important. 
Behind  it  lies  the  commencement  of  the  vena  innommata.  It  is  the  level  of  the 
division  of  the  innominate  artery  on  the  right,  and  the  level  of  the  apex  of  the 
lung.  As  to  the  apex  of  the  lung,  it  may  rise  one  and  a half  inches  and  perhaps 
two  inches  above  the  suerno-elavicular  joint.  This  is  the  point  of  the  lung 
which  is  least  apt  to  be  inflated  with  air,  and  hence  very  apt  to  be  the  seat  of 
disease.  I have  already  called  your  attention  to  its  examination  by  percussion 
at  the  sternal  end  of  the  clavicle.  The  subclavian  artery  is  also  important.  In 
the  supraclavicular  fossa,  just  at  the  outer  edge  of  the  sterno-mastoid  muscle, 
about  an  inch  above  the  clavicle  you  will  feel  the  pulsation  of  the  subclavian 
artery;  at  that  point  it  crosses  the  first  rib.  Pressure  slightly  downward  and 
inward  there  will  impinge  upon  the  subclavian  artery;  a little  pressure  is  suf- 
ficient. As  you  know,  the  outer  border  of  the  sterno-mastoid  muscle  corres- 
ponds nearly  to  the  outer  border  of  the  scalenus  anticus  muscle,  and  that  across 
the  scalenus  anticus  runs  the  phrenic  nerve.  Now,  at  about  the  point  where 
you  impinge  upon  the  subclavian  artery  you  will  also  reach  the  phrenic  nerve. 
In  fact,  the  way  Dr.  Harry  Still  often  treats  hiccoughs  is  by  standing  behind 
the  patient  and  placing  his  thumb  along  the  outer  edge  of  the  sterno-mastoid 
muscle  and  thus  reaching  the  phrenic  nerve.  Deep  pressure  at  the  unper  part 


78 


of  the  supraclavicular  fossa  will  reach  the  transeverse  process  of  the  seventh 
cervical  vertebra.  In  a long  thin  neck  it  is  stated  that  just  above,  and  nearly 
parallel  with  the  clavicle  can  be  felt  the  posterior  belly  of  the  omo-hyoid  mus- 
cle, as  it  rises  and  falls  in  inspiration. 

III.  I wish  to  conti.ne  the  examination  of  the  neck.  There  were  a couple 
of  points  that  I should  have  noted  in  going  over  the  spine,  but  they  slipped  my 
mind  at  the  time.  One  of  them  is  how  to  stretch  the  cpiadratus  lumborum 
muscle.  This  muscle  in  various  cases  will  become  contracted  and  will  then 
draw  down  the  lower  rib,  and  may  make  considerable  tronble.  I have  found 
that  I coud  treat  a lame  back  in  that  way  and  get  results  that  I could  get  in  no 
other  way.  Frequently  the  lameness  there  is  between  the  fifth  lumbar  and  the 
sacrum.  And  why?  Because  the  traction  in  the  quadratus  lumborum  muscle 
is  drawing  the  pelvis  up  and  is  bringing  a strain  at  the  point  of  junction  of  the 
fifth  lumbar  with  the  sacrum.  I have  often  removed  lameness  there  by  stretch- 
ing that  muscle.  It  takes  a diagonal  pull  to  stretch  the  quadratus  lumborum 
properly.  If  I have  an  assistant  I have  him  draw  on  the  pelvis  while  I draw 
the  arm  in  the  other  direction.  I draw  steadily,  but  do  not  jerk,  and  I put  a 
considerable  force  of  traction  upon  the  part.  Then  I have  my  asssitant  take 
the  arm,  and  I stretch  in  the  other  direction,  and  in  that  way  get  a pull  upon 
every  part  of  the  quodratus  lumborum  muscle. 

The  other  point  concerning  the  spine  was,  that  you  will  in  running  your 
hand  over  the  back  frequently  detect  changes  in  temperature.  You  will  find  a 
warmer  spot,  or,  more  frequently  a cold  streak  following  the  distribution  of 
the  inter-costal  nerves.  That  is  quite  an  important  method  of  diagnosis.  You 
should  accustom  your  hand  to  detect  differences  in  temperature.  Of  couse  that 
has  to  be  done  next  to  the  skin.  When  you  find  that,  of  course  it  indicates  at 
once  that  the  blood  supply  is  not  equally  distributed,  and  that  probably  there  is 
a lesion  along  the  spine  at  the  point  where  the  cold  streak  leaves  it.  If  you 
find  it  hot  it  may  mean  the  same,  but  we  do  not  find  that  as  often  as  we  do  the 
cold  streak. 

In  the  consideration  of  the  neck  I have  divided  it  into,  first,  the  throat, 
which  I considered  at  the  last  lecture  ; second  the  neck  proper,  which  I shall 
consider  at  this  time.  I have  already  noted  the  spines  and  peculiar  vertebrae, 
and  the  fact  that  you  can  note  the  dislocated  vertebra  sometimes  by  an  exami- 
nation in  the  pharynx  by  means  of  the  finger.  I have  called  the  atlas  to  your 
attention  and  the  fact  that  you  must  turn  the  head  from  side  to  side  in  attempt- 
ing to  examine  the  transverse  processes  of  the  vertebrae,  In  a case  of  fracture, 
which  we  may  possibly  find,  there  will  be  crepitus  and  abnormal  mobilitv  of 
the  parts.  You  should  in  your  examination  of  the  neck  look  at  the  con- 
dition of  the  superficial  and  deep  muscles.  Carefully  examine  to  note  any 
hardening  of  the  muscles.  The  hardening,  of  course,  may  be  in  the  superficial 
muscles  or  in  the  deep  muscles:  you  will  have  to  judge  as  to  where  you  think 


79 


the  tightening  of  the  muscle  is.  Examine  very  carefully  all  about  the  super- 
ficial and  the  deep  muscles.  It  is  usually  in  the  throat  that  you  find  the  super- 
ficial muscles  contracted  aud  the  deeper  ones  in  the  neck  further  back.  The 
steruo-mastoid  muscle  of  course  always  comes  prominently  to  your  attention. 
It  is  contracted  in  eases  of  torticollis ; or  it  may  be  hardened  and  produce  pres- 
sure upon  the  structures  beneath  it.  Then  examine  the  scaleni  muscles.  You 
know  how  they  are  attached,  reaching  all  the  way  from  the  second  cervical 
down  to  the  seventh  and  then  running  to  the  upper  two  ribs.  Normally  these 
muscles  will  feel  rather  hard,  you  will  become  acquainted  with  the  normal  feel- 
ing of  them.  They  are  significant  to  us  from  the  fact  that  they  sometimes  be- 
come contracted  and  bring  traction  upon  the  upper  two  ribs.  Hence  it  is  that 
any  displacement  of  these  upper  two  ribs  is  yery  likely  to  be  upwards.  This 
will  cause  heart  trouble,  or  lung  trouble,  etc.  These  muscles  are  useful  in  re- 
placing ribs  which  are  dislocated.  1 have  already  noted  the  ligamentum  nu- 
chae  ; how  you  may  find  it  and  how  you  may  treat  it.  The  neck  is  about  as 
good  a place  as  there  is  for  the  Osteopath  to  find  sore  spots.  Principally  you 
are  liable  to  find  them  in  the  fossae  just  below  the  occipital  bone.  In  fact  I 
have  been  told  that  it  is  always  naturally  sore  there,  but  I don’t  believe  it,  be- 
cause I find  lots  of  eases  that  are  not  sore  there  at  all,  and  I think  that  in  the 
normal  neck  there  is  no  soreness  there.  Of  course  you  may  impinge  at  anj’ 
time  upon  a nerve  hard  enough  to  hurt  it,  but  I am  speaking  of  examinations 
not  of  chopping  wood.  Why  these  sore  spots  occur  is  hard  to  say,  but  I think 
the  soreness  is  due  primarily  to  the  condition  of  the  great  and  suboccipital 
nerves  which  you  find  at  that  point.  I do  not  think  that  it  is  just  because  you 
touch  them,  but  they  were  sore  before  you  touched  them.  Then  you  will  often 
find  that  just  below  the  occipital  protuberance  there  is  a sore  spot,  and  just 
there  you  will  often  find  a tightening  of  the  ligaments.  The  lesion  is  impor- 
tant because  if  you  find  a sore  spot  there  or  in  the  fossa  below  the  occipital 
bone  you  are  led  to  believe  that  there  is  some  irritation  affecting  the  sub-  and 
great  occipital  nerves,  and  since  they  are  in  close  connection  to  the  superior 
cervical  gangion  of  the  sypathetie  they  may  have  an  affect  through  it  upon  the 
di-stant  parts  of  the  body.  You  should  also  examine  in  the  region  of  the  three 
ganglia  of  the  sympathetic.  The  superior  cervical  ganglion  lies  opposite  the 
second  and  third  vertebrae  on  the  scalenus  anticus  muscle.  The  second  cervi- 
cal ganglion  lies  opposite  sixth  and  seventh  cervical  vertebrae.  While  the  in- 
ferior cervical  ganglion  lies  just  below  the  seventh  cervical  vertebra,  and  is 
frequently  coalesced  with  the  first  thoracic  ganglion  of  the  sympathetic.  Quain 
puts  it  that  this  inferior  cervical  ganglion  of  the  sympathetic  lies  just  over  the 
costo-central  articulation,  that  is,  the  articulation  of  the  first  rib  with  the  spine. 
Now,  if  you  should  find  lesions  in  those  places  they  are,  of  course  significant  to 
you  according  as  they  may  affect  the  sympathetic  life  of  the  individual.  They 
may  affect  the  brain,  heart  and  lungs,  or  any  distant  part  of  the  body.  Also 


80 


remember  the  distiuctly  spinal  nerves  here,  those  of  the  cervical  and  brachial 
plexuses.  Impinge  upon  these  nerves  where  they  pass  out  between  the  scale- 
nus medius  and  scalenus  anticus  muscles  and  upon  deep  pressure  the  patient 
will  tell  you  he  can  feel  pain  in  his  shoulder  and  arm.  You  should  also  here 
look  at  the  temperature  of  the  parts  you  are  examining,  and  I think  that  no- 
where else  in  the  body  we  as  frequently  find  a cold  place  as  in  the  back  of  the 
neck.  I thought  perhaps  it  was  because  it  was  more  exposed,  but  I doubt  that 
very  much  because  I have  treated  patients  who  had  been  in  the  house  for  hours 
and  those  muscles  were  cold.  I have  treated  patients  in  the  heated  period  of 
summer  when  certainly  there  was  not  any  chance  of  there  being  exposure  to 
cold,  and  the  temperature  was  abnormally  low.  That  argues  to  your  mind 
certainly  that  there  is  some  inequality  in  the  distribution  of  the  blood  flow,  it 
may  be  a tightening  of  the  muscles  upon  the  blood  vessels,  but  it  shows  yoia  at 
any  rate  that  there  is  probably  the  seat  of  the  lesion.  In  relation  with  this  ex- 
amination you  must  look  at  the  condition  of  the  blood  supply  to  the  throat, 
through  the  neck  and  thus  to  the  brain,  which  is  important,  and  you  should  be 
very  sure  that  the  blood  supply  to  the  neck  and  brain  are  normal. 

Q.  You  spoke  of  treating  the  phrenic  nerve  above  the  clavicle.  Could  it 
not  also  be  reached  from  the  second  to  the  fifth  cervical  ? 

A.  Yes  sir,  Dr.  Harry  Still  frequently  works  right  along  the  third, 
fourth  and  fifth  cervical.  The  phrenic  nerve  arises  from  the  fourth,  also  part- 
ly from  the  third,  and  having  a connecting  branch  from  the  fifth.  So  we  get 
work  at  the  anterior  edge  of  the  scalenus  medius  and  impinge  upon  the  nerve 
by  pressing  backward  against  the  transverse  processes  of  the  vertebrae. 

Q.  Do  you  use  the  word  lesion  for  any  abnormality  about  the  bodj'f 

A.  I have  used  it  for  an  injury.  Taking  it  in  its  generic  sense  it  means 
injury.  There  is  a difference,  perhaps,  in  the  use  of  that  word,  but  we  here 
use  it  in  the  sense  of  an  injury.  That  is  the  use  I have  heard  made  of  it  ever 
since  I have  been  here.  I believe  the  books  define  it  as  some  abnormality  of 
the  tissues. 


LECTUEE  XIY. 


At  the  last  lecture  I considered  briefly  possible  lesions  of  centers.  I 
shall  carry  that  idea  farther  to-day.  What  I took  the  most  time  to  explain 
was  how  thickening  of  connective  tissue  of  parts  might  lead  to  impingement 
upon  blood  vessels  or  uiion  nerves,  showing  that,  in  the  first  place,  there 
might  be  an  irritation  caused  by  a slip  of  a vertebra,  thus  setting  up  inflam- 
mation, this  followed  by  formation  of  new'  tissue  which  has  a tendency  to  con- 
tract. I show'ed  that  the  same  thing  could  follow'  hyperemia.  Such  things, 
then,  are  significant  to  the  Osteopath,  since  they  act  as  obstructions  to  the 


81 


flow  of  blood  and  nerve  force.  Such  lesions  may,  if  not  prevented,  go  much 
further,  resulting  in  bony  ankoylosis  of  joints  or  in  ossification  of  ligaments, 
thus  setting  up  a permanent  deformity.  It  is  then  the  function  of  the  Osteo- 
path not  so  much  to  treat  that  deformity,  as  to  i>revent  it.  That  is,  in  such 
case  his  treatment  is  prophylactic. 

I then  called  your  attention  to  landmarks  in  the  neck,  and  to  certain 
points  in  how  to  examine  the  neck. 

I.  Theory  OF  WoEK  Upon  Centers.  (Continued.) — Further i)ossible 
lesions.  You  may  have  a i^ressure  upon  important  parts  by  exudates  or  by 
oedema.  An  exudate  is  in  the  nature  fluid  or  cellular,  and  it  follows  patho- 
logical processes  in  the  nature  of  inflammations  or  hj-peremia.  Having  an 
inflammation,  you  have  an  exudation  of  the  contents  of  the  blood  vessels: 
those  contents  are  fluid,  or  in  the  later  stages  of  the  exudation,  cellular.  They 
thus  may,  at  any  place,  and  do,  build  up  a considerable  thickening  among 
the  tissues,  acting  as  a mechanical  pressure  or  irritant  upon  important  parts. 
These  important  parts  may  be  blood  vessels  or  nerves.  Byron  Eobinson  says 
“The  nerves  may  suffer  from  jiressure  by  exudates  or  oedema,  congestion  or 
from  malnutrition.  The  final  outcome  is  derangement  of  the  nerves,  exalta- 
tion of  sensation  and  motion,  or  debasement  of  sensation  and  motion.”  He 
was  speaking  there  particularly  of  the  nerves  to  the  bowels.  The  Osteopath's 
duty  in  relation  to  such  things  is  that  he  must,  in  making  his  diagnosis,  take 
into  consideration  the  probability  of  there  being  such  a lesion  present.  You 
will,  of  course,  in  your  fui'ther  studies  which  will  include  pathology  and 
other  important  things,  learn  how  to  recognize  these  lesions  better  than  I can 
tell  you  here.  What  I i>ropose  to  do  is  to  use  these  things  to  illustrate  the 
subject  of  Osteopathy,  but  I cannot  of  course  go  into  detail  and  exjjlain  every- 
thing in  pathology  that  I come  across,  but  they  are  "valuable  to  you,  and  you 
will  recognize  their  importance  when  you  come  to  that  place  in  your  course. 
In  general,  you  will  recognize  or  look  for  the  process  of  oedema  in  patients 
with  lung,  kidney  or  heart  trouble,  you  will  be  very  ajit  to  find  it  in  such 
cases;  or  in  cases  where  there  is  obstruction  to  the  blood  flow.  It  may  be 
mechanical  shutting  down  ujion  an  artery,  or  it  may  be  a narrowing  of  the 
lumen  of  a vessel  from  some  disease,  or  something  of  that  kind.  The  Osteo- 
path must  judge  what  may  be  the  cause  and  work  to  remove  the  lesion.  As 
to  hyperemia,  and  its  effects  ui^on  the  cord,  I have  already  shown  this  to  you 
in  a quotation  from  Green  some  time  since,  where  he  said  it  caused  imraes- 
thesia  of  sight  or  hearing  or  perhaps  even  spasms.  But  according  to  Eobin- 
son,  this  hyperemia  may  act  mechanically  to  affect  not  centers  only,  but  di- 
rectly to  affect  nerves  through  j^ressure.  Your  lesion  may  be  malnutrition, 
but  I will  notice  that  later.  Other  lesions  which  may  produce  pressure  upon 
important  parts  are  deposits  or  growths.  I wish  to  quote  from  Dr.  Jacobson. 
Dr.  Hilton’s  editor,  where  he  says:  “Sensations  of  sharp  pains  like  knives 


around  the  trunk,  increased  by  movement,  and  a numbed  feeling  about  the 
body,  uiay  be  produced  by  gummatous  meningitis  making  pressure  upon  the 
posterior  roots  of  some  of  the  spinal  nerves.”  You  note  here  that  the 
pathological  process  is  an  inflammation,  that  secondarily  there  is  set  up  a 
Ijressure  as  the  result  of  that  inflammation,  which  is  a gummatous  dej^osit, 
thus  it  acts  as  a lesion  ijroducing  pressure.  Hilton  instances  a case,  fui'ther, 
where  there  was  pressure  uimn  the  ulnar  nerve,  causing  much  numbness, 
lack  of  sensation,  and  particularly  of  motion,  in  the  third  and  fourth  fingers. 
They  became  discolored,  and  finally  gangrenous.  (Gangrene  is  death  of  tis- 
sues.) Upon  examination  there  was  found  an  exostosis,  an  outgrowth  from 
the  bone,  upon  the  first  rib,  pressing  upon  the  ulnar  nerve  and  the  subclavian 
artery,  thus  shutting  off  the  nerve  and  blood  supply  jjartly,  the  nerve  more 
fully.  However,  shutting  off  the  nerve  sujjply  alone  would  have  been  sufficieut 
to  cause  degenerative  changes  in  the  part  affected. 

I wish  to  call  your  attention  to  this  structural  degeneration  by  pressure 
uj)on  a uerve.  Thus,  you  may  have  pressure  in  the  form  of  a foreign  growth 
or  in  the  form  of  some  excrescence  upon  important  parts.  Further,  your 
lesion  might  be  an  aneurism,  and  it  might  bring  pressure  upon  parts.  Green 
states  that  active  congestion  follows  pressure  upon  the  sympathetic,  as  for 
instance  in  the  neck  by  an  aneurism.  Thus  jnu  may  inhibit  vaso  tonic  action 
of  the  sympathetic  and  cause  hyperemia,  or  \fice  versa.  Another  kind  of 
lesion  which  will  frequently  come  to  your  attention  is  tumor,  which  you  will 
notice  also  is  of  such  a nature  that  it  i^roduces  pressure  upon  important  parts. 
You  might  take,  for  instance,  the  case  of  ex-ophthalmic  goitre;  there  you 
have  protrusion  of  the  eye  ball  due  to  a deposition  of  fat  behind  it.  That 
shows  an  over  stimulation  of  the  trophic  fibers  to  that  part  of  the  head.  There 
are  also  cardiac  symiitoms,  palpitation  and  irregularity  in  the  beat  of  the 
heart,  which  shows  an  interference  with  the  cardiac  nerves,  the  sympathetics 
receiving  pressure  from  the  goitre  in  the  neck.  And  further,  you  have  vaso 
motor  symptoms  from  the  ijressui’e  of  this  goitre,  because  you  frequently  have 
a flushing  up  of  the  cutaneous  circulation.  This  is  a good  example  of  what 
mechanical  pressure  may  do  to  influence  uerve  life.  Eobinson  also  instances 
the  case  of  an  abdominal  tumor  leading  to  fatU  degeneration  of  the  heart. 
The  impulse  sent  from  the  tumor  up  along  the  abdominal  sympathetics  to  the 
solar  plexus,  here  it  is  reorganized,  perhaps  sent  to  the  cervical  sympathet- 
ics, down  the  cardiac  branches  to  the  heart,  resulting  in  irritation  of  the 
heart,  causing  the  heart  to  over  feed  itself,  which  finally  results  in  hyper- 
trophy, followed  by  fattj'  degeneration.  Thus  you  can  learn  to  trace  the 
causes.  Almost  any  young  Osteopath  would  treat  that  effect,  heart  trouble, 
when  really  it  is  the  tumor,  far  removed  from  the  heart,  which  is  the  cause 
of  the  trouble.  In  speaking  of  abdominal  tumors,  Eobinson  says:  “The  ir- 

ritation from  the  tumor  is  carried  on  the  plexus  of  any  contiguous  viscus  to 


83 


the  abdominal  brain,  where  it  is  reorganized  and  emitted  to  the  digestive 
tract  over  the  gastric  jilexus,  the  superior  mesenteric  plexus  and  the  inferior 
mesenteric  plexus.  In  any  case  the  brunt  of  the  forces  end  in  the  ganglia 
which  lie  just  below  the  mucous  membrane.  The  ganglia  constitute  what  is 
known  as  Meissner’s  plexus,  which  rules  secretion.  If  the  irritation  be  of 
such  a nature  as  to  produce  excessive  secretion,  diarrhea  may  result;  the  ex- 
cessive secretions  will  decompose  and  induce  malnutrition.”  Thus  one  dif- 
ficulty leads  to  another.  You  might  have  constipation,  indigestion  anti  vari- 
ous troubles.  He  goes  on  to  say  that  small  tumors  on  pedicles  so  that  they 
may  swing  around,  and  roll  about,  and  pound  upon  the  abdominal  structures 
are  those  which  are  most  injurious,  for  obviously,  if  the  tumor  is  fixed,  it 
will  not  irritate  much,  but  if  it  rolls  about  and  is  qui^'e  movable  it  will  keep 
ii'ritating  the  sympathetics  and  aggravating  the  trouble. 

The  lesions  given  above  are  the  lesions  which  produce  pressure  in  the 
body,  pressure  upon  important  structures,  for  the  most  i^art  nerves.  I have 
already  in  my  lectures  noted  certain  results  that  you  would  get  from  pressure 
upon  nerves,  for  instance,  irritation,  stimulation,  inhibition,  hv-jjeremia, 
anemia,  etc.  But  I wish  to  go  further  to-day  and  show  that  the  result  may 
be  more  serious  than  a mere  inhibition  or  stimulation,  that  it  may  lead  to  de- 
generation of  the  nerve  fibers.  Thus  there  would  be  processes  of  deteriora- 
tion of  the  structure  of  the  i^arts,  especially  of  the  nerves  affected.  The  pro- 
cess of  degeneration  of  the  nerves  is  about  as  follows,  and  is  called  secondary 
degeneration,  since  it  is  secondary  to  some  primary  lesion;  it  is  also  called 
Wallerian  degeneration.  The  first  process  is  that  the  myelin  becomes  de- 
generated, the  sheath  of  Schwann  becomes  separated  into  parts,  still  later  it 
becomes  granulated,  and  finally  disappears  from  the  nerve  sheath,  perhaps 
by  the  process  of  saponification,  as  has  been  stated  by  some  writers.  During 
this  process  the  axis-cylinder,  which  is  the  important  part  of  the  nerve,  is 
segmented,  broken  down  and  removed  in  practically  the  same 

way.  Thus  you  finally  have  nothing  but  the  nerve  sheath 

left.  The  nerve  has  then  lost  its  conductivdtv’  and  is  useless 
as  a nerve.  What  I wish  to  show  is  that  pressure  upon  nerves  may  be 
bad  enough  to  induce  this  degeneration,  which  .you  can  readily  see  is  a serious 
result.  Gowers  says  : “Degeneration  follows  many  slight  lesions  of  nerves, 

compression,  overextension,  and  the  like.”  He  says  further  that  it  is  proba- 
ble that  a compression  for  a few  hours  has  such  an  effect  in  separating  the 
molecules  in  the  white  substance  of  Schwann  as  to  set  up  a secondary  degener- 
ation of  the  same  character  as  that  resulting  from  division  of  the  nerves.  This 
pressure  does  not  need  to  be  severe ; it  may  not  extend  over  a period  longer 
than  a few  hours  to  produce  finally  all  the  results  which  the  Osteopath  meets  in 
his  work.  Pressure  of  some  dislocated  paid  or  pressure  of  some  such  lesion  as 
I have  mentioned  to-day  upon  nerves,  interferes  with  the  sense  of  feeling  and 


84 


with  structure  of  other  parts,  and  may  have  a similar  effect  to  cutting  the  nerve. 
Gowers  says  that  after  division  of  a nerve  or  degeneration  of  its  fibres,  there  is 
a marked  change  in  the  muscles  supplied  by  the  motor  nerve.  This  is  a change 
which  is  a deterioration  of  their  sti'ueture. 

So  much,  then,  for  lesions  which  may  be  brought  on  by  pressure.  You 
have  seen  from  what  I have  said  what  this  pressure  may  result  from.  I wish 
to  call  your  atteution  to  the  fact  that  the  action  of  muscles  may  in  certain  eases 
become  traumatic,  wounding  a' nerve,  and  setting  up  serious  results,  often  de- 
generation. Gowers,  speaking  of  neuritis,  says:  "Nerves  are  sometimes  dam- 

aged by  a violent  contraction  of  a muscles  through  which  they  pass.  It  is  prob- 
able, also,  that  muscular  action  excites  neuritis  in  other  situations,  especially 
in  persons  who  are  predisposed.”  Also  we  may  notice  the  indirect  result  of 
traumatic  lesion  by  action  of  the  muscles. 

Bryon  Robinson,  in  speaking  of  peritonitis,  says:  ‘‘Peritonitis  is  due  to 

two  causes,  (of  which  I will  name  one.)  viz.,  trumatic  muscular  action  of  the 
psaos  magnus  on  the  sigmoid,  and  trumatic  muscular  action  of  the  lower  right 
limb  of  the  diaphragm  on  the  descending  colon.”  The  way  by  which  the  nerves 
there  are  involved  IS  this  : That  that  injury  allows  the  migration  of  patho- 

genic bacteria,  which  set  up  peritonitis,  thereby  crippling  the  nerves,  and  per- 
haps causing  considerable  degeneration  of  them.  And  this  traumatic  lesion, 
directly  bv  action  of  muscles  upon  nerves,  or  indirectly  as  in  this  case,  is  an 
important  thing  to  the  Osteopath,  and  he  must  take  it  into  consideration  in  di- 
agnosing his  cases.  You  will  learn  later  that  these  nerves  when  degenerated, 
may,  by  appropriate  treatment,  of  which  rest  and  quiet  is  an  important  part, 
be  regenerated. 

To  illustrate  the  results  of  pressure,  take  a case  of  which  Dr.  Hilton 
speaks ; being  a ease  of  fracture  of  the  radius.  The  callous  in  the  growing  to- 
gether of  the  bone  had  pressed  upon  the  ulnar  nerve  above  the  wrist,  and 
there  had  resulted,  not  a paralysis,  but  an  ulceration  upon  the  skin  of  the 
thumb  and  first  and  second  fingers.  He  also  notes  a case  in  which  pressure  of 
the  humerus  upon  the  brachial  plexus  has  resulted  in  a wasting  of  the  deltoid 
muscle  by  insufficient  nerve  supply  from  the  circumflex  nerve,  which  had  been 
impinged  upon.  That  emphasizes  the  importance  aud  necessity  of  taking  into 
consideration  everything  which  may  bring  pressure  upon  parts. 

Your  lesion,  as  I have  stated,  may  be  malnutrition.  I have  already  ex- 
plained that  to  some  extent.  Amenia  may  not  only  affect  centers  m such 
cases,  but  it  may  affect  nerve  fibres  directly,  or  the  malnutrition  may  lie  from 
a poor  quality  of  blood. 

The  question  comes  to  you,  what  can  an  Onteopath  do  in  such  cases? 
Can  he  remove  exostosis,  anuerisms,  aud  such  things  as  that”?  No.  he  can  not. 
If  you.  have  a case  of  exostosis,  it  is  a surgical  case  and  you  will  have  to  send 
it  to  a surgeon.  Aneurism  has  usually  to  be  treated  by  surgical  means.  I 


85 


have  called  these  things  to  your  attention  on  account  of  their  imiDortance,  and 
to  lead  you  to  be  upon  your  guard.  You  should  not  take  secondary  symptoms 
and  treat  them.  Be  on  your  guard  always  in  making  your  diagnosis.  Some 
of  these  lesions  you  may  remove  of  course,  such  as  the  exudates  in  hyperemia 
or  intlammation,or  the  gummatous  tumor  in  meningitrs.also  the  goitre  pressing 
upon  the  sympathetic.  All  these  things  are  subject  to  your  treatment. 

II.  How  TO  Treat  a Neck.- — I have  called  your  attention  to  how  to  ex- 
amine the  neck.  I wish  to  say  to  you  that  it  is  an  extremely  important  thing 
that  you  treat  the  neck  carefully,  for  the  treatment  of  the  neck,  more  than  anv 
other  part  of  the  body  is  to  be  done  with  great  care  by  the  Osteopath.  As  in 
the  consideration  of  the  examination  of  the  neck,  I first  take  up  the  throat,  so 
in  the  treatment  I will  notice  that  part  of  the  subject  first.  In  treating  the 
throat  your  first  duty  is  almost  always  to  note  whether  there  be  a contraction 
of  the  hyoid  muscles,  and  if  such  be  the  case  to  relax  them,  as  that  leaves  a free 
field  in  which  to  work,  since  they  may  mask  other  troubles  which  you  may  not 
notice  without  having  that  removed  first.  Your  tehnique  of  manipulation  must 
be  carefully  noted,  and  the  degree  of  force  which  you  exert,  because  there  are 
important  structures  which  you  may  injure  by  rough  pressure.  The  best  way' 
is  to  use  the  flat  of  the  hand ; the  cushions  of  your  fingers.  To  relax  the  mus- 
cles here  the  best  way  is  to  push  the  head  toward  the  side,  that  is  away*  from 
y'ou,  while  drawing  the  other  hand  toward  you.  You  do  not  have  to  rub  your 
Angers  over  the  neck  as  though  your  fingers  wei-e  a file,  as  some  people’s  fin- 
gers are.  Draw  the  muscles  with  the  fingers,  do  not  let  them  slip  over  the  sur- 
face, but  hold  against  the  muscles  and  draw  them  toward  you.  Y"ou  can  do 
this  work  as  thoroughly  as  possibe  without  any  rough  rubbing  at  all ; necks  are 
readily  chafed  sometimes,  and  if  yon  wish  to  save  the  patient  to  your  practice 
you  will  have  to  be  a little  careful  how  you  handle  his  heck. 

Next  as  to  the  tonsils.  When  you  find  an  enlarged  tonsil  and  wish  to 
treat  it,  the  first  thing  to  do  is  to  loosen  the  muscles  over  the  blood  supply  to 
the  tonsil,  which  is  from  branches  from  the  carotid  arteries.  Hence,  if  you 
have  relaxed  all  the  muscles  about  the  tonsils  both  internal  and  external,  so 
that  there  is  no  further  inpingemeut  upon  the  blood  supply  then  you  have  re- 
lieved the  lesion.  Of  eouse  if  the  lesion  is  back  in  the  neck  causing  the  nerves 
to  shut  down  over  the  vaso-motor  supply  you  must  attend  to  that.  However, 
generally  we  work  directly  in  this  way.  Give  it  a thorough  treatment,  but  not 
too  hard.  Work  along  the  angles  of  the  jaw,  and  then  work  all  down  along 
the  course  of  the  commou  carotid  arteiy,  down  as  far  as  where  the  artery  comes 
from  the  thorax  just  behind  the  edge  of  the  sterno-mastoid  muscle.  That 
should  be  done  thoroughly  ; you  should  not  be  in  a great  hurry.  Further.  I 
always  put  my  fingers  in  behind  the  clavicle ; be  careful  in  putting  your  fingers 
there  not  to  hurt,  because  it  is  a very  tender  point.  I always  put  my  fingers 
in  there,  then  approximating  the  bent  arm  to  the  face  press  it  on  above  and 


8() 


over  while  niy  lingers  lie  between  the  clavicle  and  the  first  rib.  This  relaxes 
everything;  then  bring  the  arm  down  over  the  head,  outward  and  downward  ; 
this  will  stretch  the  parts  and  stimulate  the  flow  of  Ijlood  through  the  carotid 
artery.  Perhaps  the  chief  value  of  that  movement  is  this;  We  frequently  find 
that  the  muscles  about  the  upper  part  of  the  thorax  are  drawn  and  are  making 
some  impingement  upon  or  stoppage  of  the  blood  liow  through  the  carotid  arte- 
ry, and  you  simply  give  it  freer  action  by  the  motions  you  use  there.  We  also 
frequently  stretch  the  jaw.  as  we  call  it.  I put  my  fingers  just  below  the  in- 
ferior maxillary  bone,  placing  the  thumbs  above,  usually  about  the  molar  pro- 
cess, then  holding  fairly  tight  spring  the  mouth  open,  rubbing  downward  as 
the  mouth  opens  to  relax  the  muscles.  That  should  be  done  three  or  four 
times.  It  is  not  a bad  idea  to  simply  hold  the  jaw  firmly  and  tell  the  patient 
to  open  the  mouth  while  you  are  holding,  and  that  will  stretch  the  muscles 
about  the  part.  Of  course,  in  treating  any  part  you  must  watch  its  blood  and 
nerve  supply.  We  have  mentioned  the  blood  supply  in  this  instance.  The 
nerve  supply  is  from  the  pueumogastric  and  from  Meckel’s  Ganglion  of  the 
fifth.  You  cah  stimulate  the  pneumogastric  at  its  exit  from  the  skull  by  deep 
pressure.  You  can  also  get  an  effect  upon  Meckel’s  ganglion  by  having  the 
patient  open  his  mouth,  and  thrusting  the  gngers  into  the  glenoid  fossa,  have 
him  close  it  again.  It  will  usually  hurt,  but  it  is  supposed  to  have  an  effect 
upon  Meckel’s  ganglion,  which  I will  show  later  when  I tell  you  how  to  treat 
the  neck.  The  point  there  is  the  communication  of  the  sympathetic  with  the 
pneumogastric  and  with  the  Fifth  and  vvith  the  blood  supply  about  the  tonsils. 
Thus  you  have  treated  both  the  nerve  and  blood  supply  in  treating  an  enlarged 
tonsil.  If  your  diagnosis  has  shown  you  a tender  point  just  below  the  angle 
of  the  jaw,  as  is  stated  to  be  the  ease  in  catarrh,  the  best  way  to  attend  to  it  is 
by  the  means  already  given,  viz.,  relaxing  all  the  parts.  In  that  way  you  will 
throw  fresh  life  there  and  take  away  the  pain  and  tenderness. 

Should  you  find  lymphatic  glands  enlarged  it  is  a mistake  1o  go  at  them 
and  treat  them  directly.  If  they  are  enlarged  it  is  from  some  reason.  You 
will  sometimes  find  them  enlarged  in  tonsilitis  or  in  diphtheria,  and  they  are 
enlarged  because  they  have  work  to  do  scavengers,  and  you  must  look  to  the 
original  cause.  I do  not  think  it  admissable  ever  to  work  directly  upon  those 
lymphatics,  thinking  that  that  will  take  down  the  enlargement,  especially  in 
acute  eases.  It  may  possibly  do  in  chronic  cases,  but  in  acute  eases  I have 
known  of  injury  being  done  by  rough  treatment  of  enlarged  Ivmphatie  glands 
when  the  trouble  was  somewhere  else. 

Q.  In  the  case  of  tonsilitis  would  you  not  stimulate  the  blood  awav  from 
the  tonsils! 

A When  you  have  stimulated  the  arterial  supply,  you  will  sweep  away 
the  congestion.  Whenever  you  have  attended  to  th'^  nerve  supply  there  regu- 
lating the  blood,  the  vaso-motors,  of  course  then  you  get  the  same  egect,  it  all 


87 


tends  toward  the  normal  and  to  restore  the  circulation  as  it  should  be. 

Q.  Increasing  the  arterial  flow  will  sweep  away  the  condition? 

A.  Yes,  that  is  the  tendency,  that  is  how  you  can  affect  congestion 
through  blood  supply,  but  do  not  forget  to  couple  it  with  nerve  supply  vaso- 
motor. 

Q.  I thought  the  way  to  get  at  it  was  to  drain  the  congested  part  by 
venous  withdrawal. 

A.  That  comes  partly  through  your  vaso-motor  effect,  but  if  you  can  get 
suflflcient  vis  a tergo  from  behind  to  sweep  that  all  out,  that  is  all  you  need,  and 
that  IS  readily  done. 

Q.  Do  you  always  have  a local  edematous  condition  with  inflammation  ? 

A.  I do  not  know  that  there  can  be  an  inflammation  without  edema — with- 
out an  exudation ; that  is  one  of  the  important  symptoms  of  inflammation. 

Q.  Do  you  treat  the  sympathetics  for  goitre? 

A.  The  cervical  ganglion,  all  three  of  them  I would  treat,  but  would  es- 
pecially direct  my  attention  to  loosening  the  anterior  and  posterior  muscles, 
with  the  idea  of  relieving  all  parts  and  alloving  a free  flow  of  blood  and  nerve 
force.  Of  course  you  must  do  here,  as  you  always  do,  look  for  the  Ibsion. 
You  may  And  the  clavicle  is  slipped,  or  you  may  find  that  one  of  the  vertebrie 
is  displaced — it  depends  upon  the  cause. 


LECTUEE  XY. 

At  the  last  lecture  I considered,  under  the  general  subject  of  theory  of 
work  upon  centers,  further  lesions  that  you  might  meet  in  your  work.  That 
you  might  have  pressure  by  exudates  or  edema;  that  the  exudate  might  be  fluid 
or  cellular ; that  the  Osteopath  must  take  into  consideration  the  possibility  of 
such  lesions  and  be  on  the  lookout  for  them,  thus  going  into  the  history  of  the 
case.  For  instance,  if  there  is  a history  of  inflammation,  you  will  look  tor 
such  a possible  lesion,  or  if  a history  of  congestion,  you  will  look  for  that 
lesion.  The  lesion  may  be  a congestion  bringing  pressure  upon  parts,  or  it 
may  be  malnutrition  ; it  may  be  some  kind  of  a deposit,  as  for  instance  a gum- 
matous deposit,  of  which  I instanced  a case ; the  pressure  of  the  gumma  upon 
the  posterior  roots  of  the  nerves,  where  they  emerge  from  the  spinal  column. 
I spoke  also  of  an  exostosis,  or  growth  froma  bone ; the  lesion  may  be  an  aner- 
ism  bringing  pressure  upon  the  sympathetics ; or  it  may  be  some  kind  of  a tu- 
mor, as  in  the  case  of  exophthalmic  goitre.  I then  quoted  from  Robinson  to  show 
what  the  effect  of  such  lesions  might  be.  1 went  farther  to  show  that  the  re- 
sult might  be  more  serious  than  mere  stimulation  or  inhibition  of  nerve  force, 
showing  how  it  might  cause  actual  degeneration  of  the  nerves  and  paralysis  of 
the  parts  supplied.  1 showed  you  how  such  degeneration  might  be  accom- 
plished by  the  traumatic  action  of  contraction  of  muscles.  That  although  the 


ss 


Osteopath  was  uot  able  in  every  case  to  remove  these  lesions,  he  may  prevent 
their  forming’,  or  he  may  be  able  to  recognize  the  presence  of  such  lesions  and 
send  the  patient  to  a surgeon  if  the  ease  required  surgical  interference,  without 
himself  bothering  with  them. 

1.  General  Coxsiderations. 

There  is  a question  that  sometimes  arises  in  the  mind  of  the  Osteopath,  as 
to  what  the  effect  of  stimulation  or  inhibition  will  be  upon  parts  which  he  is 
uot  attempting  to  affect,  but  which  are  connected  directly  or  indirectly  with  the 
parts  on  which  he  is  working.  In  other  words,  will  he  thus  stimulate  or  inhib- 
it other  important  paths  of  nerve  force,  and  thus,  you  might  say,  set  up  a path- 
ological result,  and  his  treatment  result  in  certain  pathological  processes  'tvhich 
were  not  intended?  Every  once  in  a while  a patient  will  say  to  yon,  such  and 
such  a thing  happened  after  jmur  last  treatment,  and  do  you  think  that  your 
treatment  could  possibly  have  lead  to  such  and  such  a trouble  ? If  you  are 
perfectly  sure  that  the  action  of  your  treatment  upon  surrounding  parts  is  not 
such  as  to  produce  pathological  results,  you  will  often  be  able  to  answer  him 
strongly  in  the  negative,  when  otherwise  he  would  think  you  to  blame  for 
something  that  happened.  You  will  frequently  meet  eases  of  that  kind.  I 
have  had  a number  of  such  questions  asked  me.  When  considering  probabil- 
ity, remember  that  the  tendency  is  always  toward  the  normal,  and  that  helps 
you  much,  unexpectedly  as  well  as  expectedly  sometimes,  not  only  where  you 
remove  a lesion  and  depend  upon  nature  to  tend  toward  tne  normal  to  restore 
things  as  they  should  be,  but  that  the  manipulation  that  \mu  make  upon  an  af- 
fected part  tends  to  restore  that  part  to  normal,  while  a manipulation  that  you 
make  upon  the  parts  associated  does  not  tend  to  the  abnormal  of  those  associat- 
ed parts  at  all,  but  that  the  effect  upon  them  is  simply  what  might  be  com- 
pared to  the  effect  of  normal  exercise.  So  that  you  need  not  be  afraid  of  pro- 
ducing pathological  results  in  that  way.  For  instance  we  have  to  treat  the 
pueumogastric  in  a case  where  the  liver  is  not  acting  properly',  and  the  intes 
tines  seem  to  be  lacking  in  stimulating  force.  Part  of  our  treatment  in  such  a 
case  would  be  directed  to  the  pneumogastrie  nerve,  since  it  has  to  do  with  these 
viscera.  Now,  the  question  is,  whether  by  stimulating,  or  inhibiting,  or  treat- 
ing those  nerves  you  would  also  have  an  effect  upon  the  lungs  and  heart,  which 
are  supplied  by  the  pneumogastrie  nerves,  an  effect  which  would  be  l>ad.  Such 
has  not  been  the  experience  at  all,  and  you  are  not  in  danger,  in  treatiuCT  the 
pueumogastric  in  such  a case,  of  having  a bad  effect  upon  the  heart  and  lung-s. 
supposing  them  to  be  normal,  because  your  treatment  tends  to  restore  the  ab- 
normal intestine  and  liver  to  the  normal,  while  it  tends  simply  to  have  the  ef- 
fect of  exercise  upon  the  other  parts,  and  there  is  certainly  nothing  bad  in  that. 
Again,  you  might  have  a case  in  which  the  splanchnics  were  involved,  and  one 
who  was  very  careful  over  questions  of  theory  might  want  to  know  whether 
treating  those  nerves  would  have  a had  effect  upon  the  kidneys.  Experience 


89 


shows  that  such  would  not  be  the  case.  Or,  for  instance,  in  the  ease  of  eye 
trouble,  you  very  frequently  find  that  the  terminal  branches  of  the  fifth  nerve, 
emerging  from  the  supra-orbital  foramen,  are  very  tender  to  the  touch,  proba- 
bly on  account  ot  a secondary  lesion  there,  abnormal  impulses  coming  from 
that  nerve  terminal  causing  the  parts  about  the  foramen  to  contract  and  im- 
pinge upon  the  nerve,  thus  keeping  it  tender.  That  ma}'^  be  the  cause  of  it. 
Now,  of  course  in  treating  there  you  simply  remove  the  contraction  about  the 
parts,  you  stimulate  the  blood  vessel  there,  and  the  nerve,  and  remove  the  sore- 
ness, and  you  would  not  be  afraid  of  interfering  with  the  nutrition  of  the  eye, 
which  is  innervated  by  the  fifth  nerve.  This  will  serve  pariicularly  to  explain 
the  effects  obtained  by  those  who  are  not  entitled  to  the  right  to  pradice  Oste- 
opathy, certainly  of  those  who  have  seen  the  pecuniary  benefits  of  Osteopathy 
and  have  gone  out  without  proper  equipment,  and  have  become  what  the  -‘Old 
Doctor”  calls  “engine  wipers,”  and  I presume  others  who  have  had  better  op 
portunities  may  work  in  the  same  w'ay.  That  is,  they  work  all  over  the  patient, 
and  work  pretty  near  a half  hour,  so  that  the  patient  will  think  he  has  had  a 
good  treatment,  so  that  if  there  is  a place  that  should  be  treated,  he  will  be 
sure  to  hit  it.  That  is  the  way  the  Osteopathic  quack  will  work  in  most  in- 
stances, taking  into  consideration  that  the  effect  is  toward  the  normal,  he  gives 
a nice  stimulating  treatment  all  over  the  body,  and  if  he  strikes  a few  h sions 
they  may  be  helped,  as  the  tendency  is  toward  the  normal.  That  will  explain 
how  he  happens  to  get  results  in  some  cases.  Then,  our  work  is  to  remove  the 
lesion,  and  not  to  be  afraid  that  we  will  disturb  the  normal  conditions. 

Further,  concerning  work  upon  abnormal  parts,  it  is  considered  as  a priu- 
mple  in  our  practice  that  we  should  work  against  the  resistance  we  meet.  That 
is  a little  hard  to  explain,  and  it  is  not  a principle  which  will  apply  as  generallv 
as  some  others.  That  is,  to  move  the  part  in  the  direction  in  which  yon  will 
cause  the  unnatural  tension  to  appear,  because  if  by  moving  the  part  in  a cer- 
tain direction,  as  for  instance,  flexing  the  limb,  you  find  that  there  is  an  un- 
natural tension  opposing  the  normal  movement,  you  then  see  you  have  a lesion 
with  which  you  are  dealing,  and  in  working  against  the  unnatural  tension  you 
are  working  against  the  lesion,  at  least  in  some  eases.  This,  then,  becomes  a 
method  of  how  to*work  to  remove  certain  lesions.  Dr.  Harry  says  he  always 
“springs  the  part,”  as  he  expresses  it,  in  the  direction  to  cause  the  most  pain. 
Frequently  you  will  find  that  the  manipulation  that  yuu  put  upon  a part  will  be 
diagnostic  in  part,  and  that  it  will  often  reveal  to  you  certain  lesions  of  the 
kind  I have  described.  Remember,  that  in  such  cases  your  cue  is  the  pain  that 
you  find.  For  instance,  I might  find  a contraction  in  the  pyriformis  muscle  in 
case  of  sciatica.  The  cause  frequently  of  sciatica,  from  our  standpoint,  is  a 
contraction  of  this  pyrifonuis  muscle  in  such  a way  as  to  impinge  upon  the 
sciatic  nerve,  which  runs  under  it.  So  that  you  will  then  have  an  abnormal 
tendency  to  the  external  rotation  of  the  head  of  the  femur,  and  the  movement 


90 


that  we  adopt  is  of  such  a nature  as  to  stretch  the  pyriform  is  muscle.  The 
same  thing  is  seen  in  the  stretehiug  of  the  ligamentum  nuchae,  or  the  slretch- 
iug  of  the  sterno-mastoid  muscle.  I have  seen  cases  in  which  that  muscle  was 
stiffened  and  contracted,  in  wry  neck,  and  the  treatment  vvas  to  stretch  the  mus- 
ele.  This  will  illustrate  what  I mean  when  I say  to  work  against  the  resistance 
which  yon  will  find,  and  that  that  is  a cue  to  the  lesion  itself.  Of  course  that 
may  not  be  a primary  lesion,  it  may  be  a secondary  lesion  as  in  the  ease  of  the 
sterno-mastoid,  the  primary  lesion  may  be  something  affecting  the  spinal  acces- 
sory which  innervates  that  muscle,  but  at  any  rate  it  has  set  up  a certain  troub- 
le which  must  be  corrected.  That  is  not,  as  I said,  a general  principle  ; you 
cannot  apply  it  everywhere ; it  applies  especially  to  parts  which  may  contract 
and  thus  form  obstructions.  Do  not  be  too  eager  in  carrying  out  this  idea,  be- 
cause you  may  ir.ntate  the  parts.  In  trying  to  get  the  cue  you  may  do  harm  ; 
I have  seen  that  done. 

In  the  removal  of  lesions  the  question  of  stimulation  or  of  inhibition  be- 
comes secondary,  since  the  lesion  being  removed,  nature  tends  toward  the  nor- 
mal. Nevertheless,  there  come  times  in  our  practice  when  we  must  either  stim- 
ulate or  inhibit  according  to  the  rules  laid  down.  As  for  instance,  after  we 
have  removed  the  lesion  and  we  have  still  to  treat  the  parts  to  strengthen  them, 
the  question  arises  once  more,  what  shall  we  do  in  this  case,  stimulate  or  in- 
hibit: so  that  our  work  is  not  entirely  confined  to  the  removal  of  lesions. 
Sometimes  the  lesion  is  not  apparent,  and  we  simply  have  to  go  to  work  at  the 
innervation  of  the  parts  and  get  the  results  that  we  desire,  either  by  stimulation 
or  by  inhibition.  The  disease  may  be  of  such  a nature  that  this  will  be  the 
rational  method  of  treatment.  Not  that  we  should  not  look  for  lesions  ah,  ays, 
but  sometimes  we  have  to  get  to  work  directly  upon  nerves.  For  instance,  in 
diarrhea  or  flux,  their  abnormality  must  be  of  nerve  force,  it  frequently  hap- 
pens that  we  simply  have  to  treat  that  case  by  strongly  holding  the  spine,  that 
is,  inhibiting  the  sympathetic  nerves,  even  though  we  may  not  at  tliat  time  cor- 
rect some  lesion  in  the  spine.  I frequently  simply  inhibited  strongly  all  along 
the  lumbar  region,  and  I certainly  did  nothing  there  but  inhibit  nerve  action. 
Ill  obstetrics  the  partuition  center  is  stimulated  at  certain  times  to  cause  the 
contraction  of  the  circular  fibers  of  the  uterus  ; we  are  not  removing  a lesion  in 
that  case,  we  are  stimulating  to  bring  about  the  desired  end.  and  are  working 
upon  the  nerves  which  control  those  muscles.  In  some  headaches  we  cannot 
find  any  particular  lesion ; we  very  frequently  go  to  the  siili-occipitals  and  hold 
them  and  inhibit  them  there — the  sub- and  great  oceipitals  ; in  that  case  we 
have  inhibited.  In  the  case  of  epistaxis  we  must  simply  stimulate  in  the  neck, 
or  in  the  case  of  hiccoughs,  which  is  a very  good  example,  we  often  do  uotliiug 
but  go  to  the  phrenic  nerve  and  inhibit  it  by  bring  pressure  upon  ir.  So  I think 
the  point  is  well  taken,  that  we  must  sometimes  stimulate  or  inhibit  without 
removing  lesions,  either  after  removal  of  lesions,  or  in  the  absence  of  discover- 


91 


able  lesions.  That  then  brings  np  the  point  that  there  must  be  some  different 
movement  which  we  employ  to  stimulate  or  inhibit.  The  difference  in  stimu- 
lation and  inhibition  is  well  illustrated  by  a simple  phenomenon — a very  light 
touch  over  different  parts  of  the  body  will  cause  a tickling  sensation,  which 
may  become  almost  unbearable ; whereas  a firm  pressure  at  the  same  place 
simply  removes  the  conductivity  of  the  nerves  or  inhibits.  The  other  was  a 
stimulation.  In  general  the  movement  used  to  inhibit  is  a holding  or  pressing 
motion  ; I will  show  you  that  later;  a holding  or  pressing  motion,  having  as 
its  end  in  view  the  idea  of  quieting  the  excitability  of  the  nerve,  that  is,  the 
lessening  of  its  conductivity,  which  we  know  is  done  by  pressure.  We  have 
seen  that  to  be  a fact  according  to  the  authorities.  Thus,  in  that  pressure  upon 
the  phrenic  nerve  we  quieted  the  spasm  of  the  hiccough.  In  general,  alterna- 
tion of  pressure  and  relaxation  of  pressure,  is  used  to  stimulate,  the  idea  being 
to  excite,  to  titillate,  and  this  is  comparable  to  the  “making  and  breaking”  of 
an  electric  current.  We  use  alternate  pressure  and  relaxation,  and  the  idea  is 
to  in  that  way  arouse  nerve  force.  For  instance,  in  a ease  of  nose  bleeding  we 
have  to  rub  the  superior  cervical  ganglion,  and  thus  stimulate  the  tonicity  of 
the  blood  vessels.  In  stimulating  we  work  frequently  along  the  spine,  giving 
a stimulating  treatment,  described  by  one  as  working  hard  and  fast,  making 
and  breaking.  We  simply  keep  working  in  that  way.  We  do  not  adopt  the 
pressing  motion,  what  we  use  is  a quick,  stimulating  motion.  At  least  that  is 
the  Osteopathic  view  of  how  we  stimulate  or  inhibit.  That  is  the  technique  of 
manipulation.  Perhaps  I do  not  fully  agree  with  all  that  the  physiologists  say 
on  the  subject  of  stimulation  and  inhibition,  but  I think  1 have  shown  that  we 
have  a pretty  good  allowance  of  authority,  from  quotations  made,  and  that  is 
the  way  we  get  results.  This,  then,  would  naturally  bring  us  to  consider  the 
question  of  the  degree  of  force  that  we  should  use.  It  is  certain  that  you  can 
stimulate  so  assiduously^  that  you  can  get  the  opposite  result,  and  finally  in- 
hibit instead  of  stimulate.  The  secret  of  it  is  that  stimulation  must  amount  to 
irritation,  which  if  performed  too  frequently  or  if  done  too  hard  will,  after  it 
has  run  its  course,  result  in  the  nerve  refusing  to  respond  to  the  usual  'timu- 
lus,  and  finally  to  respond  to  any' stimulus  if  the  irritation  is  carried  far  enough. 
So  that  stimulation  may  become  irritation,  and  finally  inhibition. 

You  must  remeniber  in  treating  a patient  to  adapt  the  degree  of  force  to 
the  end  in  view.  This  refers  not  only  to  the  treating  of  a case,  how  hard  to 
treat  at  the  time,  but  the  treating  of  a ease  too  often.  I wish  you  could  all 
have  heard  what  Dr.  Conner  said  yesterdays  concerning  the  practice  outside. 
He  said  a great  manys  cases  have  to  be  treated  too  often.  A patient  comes  into 
your  office,  and  yson  tell  him,  “I  want  to  see  you  not  more  than  once  a week,  in 
your  case  I can  do  yon  as  much  good  in  treating  ymu  once  a week  as  I could 
treating  you  three  times  a week  or  every  day.”  And  that  is  a fact,  but  the 
patient  wants  to  get  all  he  can  for  his  money,  and  he  says,  ‘A'cii  are  charging 


lue  $2')  a month  and  I think  I ought  to  get  moi’e  than  four  or  five  treatments, 
that  makes  it  come  pretty  high,  and  I would  like  at  least  two  treatments  a 
week.”  And  it  is  almost  impossible  to  prevent  treating  too  frequently,  but 
when  you  do,  of  course  you  are  in  danger  of  irritating.  As  I say,  you  must 
explain  to  the  patient  that  by  treating  so  often  you  irritate  these  nerves  and 
structures  and  thus  keep  up  an  abnormal  irritation  instead  of  removing  it. 
You  might  also  say  that  it  is  not  you  who  cures,  but  Nature  cures;  you  simply 
aim  to  assist  Nature.  Now,  if  you  should  treat  so  often,  tell  him  you  do  not 
give  Nature  time  enough  between  times  to  work,  and  that  you  do  not  think  it 
best.  You  have  to  learn  these  arguments  that  apply  to  such  cases,  as  you  will 
meet  them  frequently.  When  you  say  to  Nature  that  you  will  aid  her  so  much 
that  she  does  not  have  to  work  at  all,  she  finally  gets  tired  of  the  effort  and 
simply  lays  off  and  lets  you  do  what  you  can.  We  had  a case  in  Chicago  of 
neuralgia  of  the  fifth  nerve  which  was  treated  once  and  disappeared  for  quite 
a long  time.  It  finally  returned  and  was  quite  a severe  case,  as  hard  a case  to 
treat  as  any  that  I had  ever  seen.  We  tried  all  sorts  of  treatment  and  finalli' 
got  to  treating  it  pretty  nearly  every  day.  and  it  did  not  do  much  better.  Final- 
ly we  told  the  gentleman  not  to  come  back  to  us  inside  of  a week  or  two  weeks, 
we  had  by  this  time  quit  taking  his  money,  but  were  trying  to  do  what  we 
could  for  him,  so  he  was  willing  to  do  that.  The  result  was  improvement  We 
had  simply  stimulated  until  we  had  irritared  and  had  kept  up  the  abnormality. 

Then,  again,  some  lesions  must  be  removed  only  gradually.  If  you  go 
to  wmrk  and  remove  the  lesion  instantly,  you  do  uot  give  nature  time  to  ac- 
commodate herself  to  the  changed  conditions.  Nature  has  been  for  years  at 
work  trying  to  adapt  herself  to  the  unnatnral  condition  of  things,  and  she  has 
done  so  to  a greater  or  less  extent  finally,  and  now  you,  as  an  Osteopath,  try 
to  change  all  that  in  a second’s  time.  It  can  rarely  be  done.  I have  known 
some  eases  where  a very  quick  change  of  a lesion  could  be  made,  but  it  is 
not  a very  common  occurrence.  I have  heard  Dr.  Harry  Still  state  that  he 
had  set  a hip  too  soon  and  he  had  great  difficulty  with  it  until  he  had  got  it 
out  again,  because  the  muscles  were  all  so  contracted  by  being  adapted  to  the 
abnormal  conditions.  They  would  not  relax  as  they  would  normally  have 
done  when  the  hip  was  in  place,  and  he  had  great  trouble  to  get  it  out  again. 
The  lesion  should  not  be  reduced  too  soon.  In  a case  of  asthma  the  “Old 
Doctor’  ’ says  you  should  uot  treat  oftener  than  once  in  ten  days  or  two  weeks, 
because  by  frequent  treatment  we  keep  up  the  irritation. 

I wish  as  soon  as  xtossible  hereafter  to  take  up  certain  centers  and  the 
consideration  of  the  symj)athetic  system,  that  I left  aside  after  the  first  few 
lectures,  as  it  is  an  important  subject.  There  are  certain  things  which  I wish 
to  bring  to  your  attention  to-day  in  regard  to  them.  Eemember  that  stimu- 
lating accelerator  fibers  accelerates  and  stimulating  inhibitory  fibers  inhibits. 
For  instance,  if  you  were  to  tre  it  the  heart  and  wish  to  stimulate  its  action. 


you  will  recollect  that  there  are  two  sets  of  nerves  innervating  the  heart;  one 
the  syinpathetics,  and  the  other  from  the  pneuniogastric.  That  the  sympa- 
thetic keeps  the  heart  running  and  tends  to  run  it  too  fast,  while  the  inhibi- 
tory influence  of  the  pneumogastric  is  to  bring  about  an  equilibrium  between 
the  forces  and  keep  it  running  just  right.  If  it  is  not  running  just  right,  not 
fast  enough,  you  will  want  to  stimulate  it  a little,  in  which  case  you  would 
stimulate  the  sympathetic  supply  to  the  heart  through  the  upper  dorsal  and 
the  cervical  ganglia  and  you  would  inhibit  the  pneuniogastric  so  as  to  remove 
the  inhibitory  influence.  You  would  thus,  according  to  the  theory,  get  a 
stimulating  effect  upon  the  heart.  If  you  wish  to  quiet  the  heart’s  action 
you  would  adopt  just  the  opposite  plan  of  treatment.  That  will  illustrate  the 
fact  that  stimulating  a nerve  stimulates  it  to  its  action,  whether  its  action  be 
that  of  an  accelerator  or  an  inhibitor.  Stimulating  vaso-dilators  dilates. 
Stimulating  vaso-constrictors  constricts.  This  is  very  simple  and  perhaps 
it  seems  unnecessary  to  call  it  to  your  attention  except  in  the  connection  it 
has  with  these  other  things.  There  are  certain  things  to  remember  in  rela- 
tion to  the  vaso-motor  system,  and  which  though  hard  to  exqilain  are  of  a 
great  deal  importance  to  the  Osteoiiath.  There  are  certain  things  concerning 
the  centers  and  the  fibers.  It  is  said  that  vaso-motor  fibers  are  present  in 
some  cranial  nerves,  for  instance,  the  chorda  tympaui  of  the  fifth  nerve.  The 
chorda  tympani  is  the  vaso  dilator  of  the  submaxillary  gland.  The  general 
vaso  motor  center  is  in  the  medulla.  It  is  said  by  Howell's  Text  Book  how- 
ever, that  that  center  is  a constricting  center,  from  which  a coutinual  cou- 
strictor  imi^ulse  goes  to  all  parts  of  the  body,  preserving  the  proper  tonicity 
of  the  blood  vessels,  but  he  says  it  is  not  proven  that  there  is  any  vaso-dila- 
tor  center  in  the  medulla.  Simply  not  proven;  there  may  be,  however.  The 
vaso -con stricter  fibers,  as  before  stated,  leave  the  spinal  cord  from  the  second 
dorsal  to  the  second  lumbar,  while  vaso-dilators  leave  the  cord  all  the  way 
along,  being  not  limited  to  certain  places. 

We  frequently  meet  with  the  terms,  in  descrii^tion  of  the  circulation,  in- 
crease of  blood  pressure,  and  so  on.  Eemember  that  stimulating  vaso  con- 
strictors constrict  the  blood  vessels,  and  thus  lesseus  the  quantity  of  blood 
in  that  part,  but  it  increases  the  blood  i)ressure.  On  the  other  hand,  the 
vaso-dilators  loosen  the  tissues  and  allow  more  blood  to  go  to  the  part,  but 
decrease  the  amount  of  blood  pressure.  I thought  I would  call  that  to  your 
attention  so  you  would  not  get  those  facts  confiised. 

A further  fact  that  you  must  take  into  consideration  is  that  sometimes  a 
single  anatomical  nerve  will  contain  more  than  one  kind  of  fibers,  vaso-dila- 
tor  and  vaso-constrictor  fibers.  That  is  true  in  the  case  of  the  sciatic 
nerve,  and  the  result  you  would  get  in  stimulating  the  sciatic  nerve 
would  be  an  average  result  betweeu  vaso-dilator  ijower  and  vaso-con- 
strictor power.  Again,  sometimes  stimulating  a center  will  produce  vaso- 


94 


dilation  and  sometimes  vaso-constriction.  You  might  have  a vaso-dilator 
center  and  expect  it  always  to  produce  vaso-dilation,  but  according  to  Howell’s 
Text  Book  the  center  is  sometimes  changed  in  condition,  and  you  get  the  op- 
posite effect  by  its  stimulation.  Vaso-constrictors  are  less  easily  excited  than 
vaso-dilators.  Vaso-constrictors  degenerate  more  rapidly  when  injured. 
The  maximum  effect  of  stimulation  is  more  readily  reached  in  vaso-constric- 
tors than  in  vaso-dilators.  Yaso-motor  nerves  are  axis  cylinders  of  synq^a- 
thetic  nerve  cells.  The  pilo-motor  and  secretory  fibers  we  shall  consider  later 
when  speaking  of  the  structures  in  which  they  terminate.  As  we  cannot  be 
certain  of  all  these  things  we  have  to  depend  more  than  ever  upon  the  tend- 
ency toward  the  normal — we  cannot  always  work  to  get  a set  vaso-motor  or 
vaso-dilator  effect. 

II.  Treatment  OF  THE  Aec'K.  (Continued.) — The  spinal  accessoiT, 
pneumogastric  and  glosso-pharyngeal  nerves  emerge  at  the  jugular  foramen. 
\Ve  frequently  have  to  treat  them,  especially  the  pneumogastric  and  the 
spinal  accessory;  the  lineumogastric  perhaps  more  often.  \Ve  treat  them  in 
various  ways.  ^Ye  can  reach  the  iJiieumogastric  by  deep  pressure  over  the 
exit  from  the  skull — deej)  pressure  just  below  the  mastoid  process  will  affect 
the  nerve.  Some  work  there.  Others  on  the  pneumogastric  by  stimulating 
all  along  the  anterior  border  of  the  sterno  mastoid  muscle.  Thus  you  get  a 
sort  of  a massage  and  direct  mechanical  i^ressure  upon  that  nerve  and  no 
doubt  affect  it  there  if  our  theories  are  correct.  Another  very  good  way  to 
reach  these  three  nerves  is  through  the  superior  cervical  ganglion.  That  is, 
we  work  on  the  superior  cervical  ganglion  to  affect  them.  We  may  affect 
the  superior  ganglion  by  working  on  the  sub  and  great  occipital  nerves.  That 
is  rather  an  indirect  way,  but  it  is  claimed  that  we  get  an  effect  uijon  those 
nerves  by  working  that  in  place.  That  is  the  method  Dr.  Hildreth  used  to 
reach  those  the  nerves. 

There  are  various  ways  in  which  we  reach  the  phrenic  nerve,  one  way  is 
to  carefully  find  its  location  opposite  the  transverse  processes  of  the  third, 
fourth  and  fifth  cervical  vertebra?,  and  get  slightly  in  front  of  them  and  im- 
pinge back  upon  them,  thus  pressing  the  nerve  against  the  transverse  pro- 
cesses. That  is  one  way.  The  way  that  Dr.  Harry  Still  treats  the  phrenic 
nei’ve  is  by  thrusting  the  thumb  between  the  clavicle  and  the  tii'st  rib  above; 
that  is,  thrusting  it  above  the  clavicle,  between  it  and  the  first  rib,  then  push- 
ing the  bent  arm  and  baud  on  back  over  the  shoulder  in  this  way,  thrusting 
the  thumb  deeply  in  there  at  the  sternal  end  of  the  clavical  and  holding  in  or- 
der to  imj)inge  upon  the  nerve  and  lessen  its  conductivity,  thus  inhibiting  the 
action  of  that  nerve.  It  is  sometimes  reached,  as  I showed  you  tlie  other 
day  by  pressure  at  the  sternal  end  of  the  clavicle.  You  can  either  press  in 
the  fonticulus  gutturis,  slightly  backward,  or  between  the  sternal  and  chivic- 
ular  ends  of  the  origin  of  the  steimo  mastoid  muscle,  backward  and  inwai'd. 


95 


to  imjDinge  upon  the  nerve.  The  best  place  to  treat  it  is  the  best  place  that 
your  practice  tells  you  you  can  reach  it.  Different  ones  treat  in  different 
places,  and  it  also  depends  upon  the  i^atient,  as  to  how  thick  or  how  thin  his 
neck  is. 

Next  we  will  consider  the  treatment  of  the  sterno  mastoid  mu.scle.  We 
can  get  a direct  sort  of  a massage  by  working  right  along  its  course.  It  is 
very  readily  worked  upon  in  this  way,  relaxing  it  and  dra’wing  it  toward  you 
without  rubbing  the  fingers  over  the  neck.  Another  way  is  to  follow  the  ob- 
liquity of  the  muscle  and  turn  tlie  head,  thus  stretching  the  muscle  on  the 
same  side.  Eemember  that,  on  account  of  the  obliquity  of  the  muscles  be- 
hind, you  will  at  the  same  time  stretch  them,  and  I find  that  a very  good 
plan  in  giving  the  neck  a general  treatment,  as  I will  show  you  later.  Of 
course  you  may  have  some  trouble  with  the  spinal  accessory  nerves  causing  a 
stiffening  of  the  sterno -mastoid,  in  which  case  you  must  give  it  attention. 

Now  as  to  treating  the  neck  proper,  or  the  back  of  the  neck.  The  first 
thing  is  to  loosen  up  all  of  the  muscles.  In  giving  this  treatment  I always 
use  the  flat  of  my  hands,  and  lay  them  directly  on  the  neck,  and  have  thus  a 
broad  hold  and  do  not  run  any  risk  of  hurting  by  pressure  with  the  tips  of 
fingers.  I usually  go  to  work  in  this  way  and  work  straight  backwards,  thus 
loosing  all  of  the  muscles,  giving  a certain  twist  or  turn  as  I work.  You  will 
be  able  to  recognize  by  the  sense  of  touch  when  you  have  relaxed  everything. 
It  is  also  good  to  relax  the  muscles  by  working  from  the  side.  Eemember, 
above  the  third  cervical  to  work  upward  and  below  it  downward.  I simijly 
relax  all  the  muscles  that  are  rigid.  Then  when  you  have  them  thoroughly 
relaxed,  it  is  a good  idea  to  still  further  relax  the  deeper  structures  by  a 
straight  pull.  I hold  beneath  the  jaw  and  occii^ital  iirotuberauce  and  draw 
the  patient  toward  me,  that  stretches  the  neck.  I have  warned  you  not  to 
turn  it  while  stretching  it  in  that  way.  I then  turn  the  neck  strongly  from 
side  to  side  in  this  general  treatment  of  the  neck,  loosening  all  the  deeper 
structures,  stimulating  all  the  parts  about  the  vertebra?  and  loosening  the 
ligaments.  Then  before  finishing  the  neck  I usually  stretch  the  ligamentum 
nuchte  and  also  the  other  ligaments  about  the  vertebrne,  as  I have  already 
shown  you  how  to  do. 

It  is  an  important  question  how  to  treat  the  cervical  ganglia  of  the  sympa- 
thetic. As  I said,  we  usually  affect  them  by  treating  the  sub-  and  great  occip- 
ital nerves,  that  is,  by  pressure  in  the  sub-occipital  foss;e.  The  way  iu  which 
we  inhibit  their  action  is  by  holding  deeply  in  those  foss:e  and  then  turning 
the  head  from  side  to  side,  rotating  it  as  you  go,  aud  you  thus  work  deep  into 
the  parts  trying  to  get  direct  pressure  upon  the  sub-  aud  great  occipital  nerves. 
Through  their  conuectiou  with  the  cervical  sympathetic  you  influence  it.  Some 
operators  treat  that  way  almost  entirely  aud  results  would  indicate  that  they 
were  accomplishing  what  they  were  attempting.  You  must  not  be  in  a hurry. 


9(5 


but  turn  the  head  from  side  to  side  and  hold  firmly.  Some  treat  the  first  gan- 
glion directly  by  pressure  opposite  the  second  and  third  cervical  vertebra?,  a 
little  in  front  and  backward,  thus  impinging  it  against  the  hard  parts  of  the 
spines  beneath.  In  the  same  way  you  can  reach  the  second  one,  the  third  I 
think  you  cannot  reach  from  the  front  of  the  neck,  that  innst  be  reached  indi- 
rectly through  sympathetic  connections  with  the  spinal  nerves  behind. 

To  stimulate  these  ganglia,  pressure  and  relaxation  are  employed. 

In  treating  an  atlas  we  use  a combination  of  motions  already  shown,  that 
is,  a thorough  loosening  up  of  all  the  parts.  Then  by  traction,  rotation  and 
pressure  upon  the  prominent  part  you  can  work  it  back  into  its  place.  Of 
course  it  takes  time,  and  frequently  has  to  be  done  very  slowly.  That  same 
method  can  be  pursued  for  all  the  cervical  vertebrm.  It  is  something  you  will 
have  to  learn  by  experience.  Another  way  to  set  the  atlas  is  with  the  patient 
sitting  on  the  chair.  This  is  a movement  that  Dr.  Still  showed  us  not  a great 
while  ago.  He  gets  his  knee  under  the  jaw  and  rotates  the  head  in  a direction 
to  throw  out  very  prominently  the  part  which  is  out  of  place,  and  then  getting 
his  thumb  or  fingers  upon  that  part  and  simply  rotates  the  head  back  again, 
the  idea  being  extension  and  flexion  in  such  a way  as  to  disengage  the  articu- 
lar processes  and  allow  the  part  to  resume  its  normal  position. 

In  order  to  work  out  the  sore  places  that  you  will  frequently  find  in  the 
sub-occipital  fossm  and  just  beneath  the  occipital  protuberance  you  should  re- 
lax all  the  parts,  both  the  ligaments  and  the  mnscles. 

I will  now  show  you  how  I usually  work  upon  the  neck : I will  work  just 
as  if  I had  come  in  and  found  this  neck  in  a generally  bad  condition  and  wish 
to  relieve  it.  The  treatment  of  the  neck  is  a very  important  thing.  You  need 
noi  be  afraid  of  getting  down  close  to  the  shoulder  and  stretching  all  of  those 
muscles.  It  is  a good  thing  to  get  the  head  against  you  and  push  downward 
as  you  turn,  you  can  thus  sometimes  relax  the  parts  and  start  the  vertebrm 
toward  their  normal  position.  It  takes  considerable  time  to  treat  a neck 
thoroughly  and  well.  One  thing  which  I did  not  mention  is  that  you  can 
stretch  the  scaleni  muscles  very  readily  by  holding  the  head  straight  and  turn- 
ing it,  pushing  it  directly  to  the  side.  If  it  is  a case  of  headache  I save  the 
inhibiting  movement  until  the  last,  and  by, holding  firmly  in  the  superior  cervi- 
cal region,  particularly  at  the  sub-occipital  fossm,  I get  good  results  as  a rule 
on  the  head  in  that  way. 

Q.  You  were  speaking  of  stretching  the  pyriformis  muscle.  Please 
show  us  how  that  was  done? 

A.  That  muscle  is  on  external  rotator,  and  an  extreme  internal  rotation 
will  be  all  that  is  necessary  to  stretch  it.  Work  opposite  to  the  defect. 


97 


LECTUEE  XYI. 

At  the  last  lecture  I invited  your  attention  first  to  the  general  principle  of 
our  treatment,  that  manipulation  always  tends  to  restore  parts  to  normal,  fol- 
lowing it  out  along  the  idea  that  therefore  should  we  manipulate  a part  which 
was  not  diseased,  we  need  not  be  in  any  fear  that  we  would  make  it  abnormal, 
because  the  tendency  would  be  to  excite  it  in  the  way  that  normal  exercise 
would  excite  it.  But  we  by  manipulation  of  the  abnormal,  on  account  of  this 
tendency,  result  in  tending  to  tbe  normal  and  in  helping  to  cure  the  disease. 
That  is  a partial  explanation  of  why  our  friends,  the  ‘'engine  wipers,”  who 
work  over  nearly  all  the  body  and  work  for  nearly  an  hour,  can  get  some  re- 
sults, when  they  are  not  Osteopaths  at  all.  Another  point  was  that  you 
should  take  the  pain  as  the  cue,  and  to  work  the  part  or  stretch  it  in  the  direc- 
tion in  which  you  get  the  resistance,  since  thereby  ^ou  work  against  the  lesion. 
I explained  about  how  general  that  should  be,  that  yon  should  not  irritate  in  so 
doing.  Although  the  question  of  stimulation  and  inhibition  is  a secondary  one 
to  removal  or  lesion,  that  we  sometimes  stimulate  or  inhibit  irrespective  of 
lesion  or  after  removal  of  it.  In  general,  we  inhibit  by  pressure,  by  holding: 
and  stimulate  by  brisk  work  like  making  and  breaking  of  an  electric  current, 
and  that  there  was  a question  of  degree  of  force ; that  you  might  stimulate 
hard  enough  to  inhibit.  There  w-ere  certain  elementary  points  concerning 
nerves  which  I thought  would  be  profitable  to  bring  to  your  attention : That 
stimulating  an  accelerator  nerve  accelerates,  stimulating  a vaso-dilator  dilates, 
stimulating  a vaso-constrietor  constricts.  I also  called  certain  centers  to  your 
mind,  the  fact  that  the  center  in  the  medulla  is  a vaso-constrictor  center,  and 
that  a vaso-dilator  center  has  not  been  found  to  exist,  although  it  may  be  there. 

I.  The  Phrenic  Nerve.  What  I wish  to-day  to  do  is  to  notice  more  par- 
ticularly something  concerning  the  phrenic  nerve.  You  all  know  its  location 
and  treatment;  how  it  arises  from  the  3d,  4th  and  5th  cervical  nerves,  espec- 
ially the  fourth,  having  some  branches  from  the  third  and  a recurrent  branch 
from  the  5th  ; that  it  is  reached  in  different  ways  : being  impinged  against  the 
transverse  processes  of  the  ver-tebne,  or  being  reached  at  the  fouticulus  gnt- 
turus,  or  between  the  first  rib  and  the  clavicle;  that  it  is  important  to  us,  but 
has  been  so  mainly  as  a means  of  stopping  hiccoughs.  However,  I think  it 
should  be  of  greater  importance  to  the  Osteopath,  and  while  I have  not  heard 
these  matters  brought  out  that  I am  going  to  bring  out  this  afternoon,  yet  I 
mention  them  in  the  way  of  suggestion  for  further  work.  Perhaps  I do  not 
tnow  all  that  others  have  done  with  the  phrenic  nerve ; these  points  are  more 
in  the  manner  of  theories,  but  if  what  I have  alreadv  said  is  true,  certaiulv  the 
phi’enie  nerve  has  considerable  importance  to  us  as  an  adjuvant  to  our  work. 
The  phrenic  nerve  has  important  connections  with  the  SA'iupathetic  system. 
Gray  says  that  the  phrenic  nerve  supplies  the  pericardium  and  the  pleura  by 
filaments;  that  in  the  thoracic  cavity  a filament  is  seen  from  the  sympathetic 


98 


joining  the  phrenic  nerve,  and  that  there  are  also  branches  to  the  peritoneum. 
From  the  right  nerve  there  are  branches  to  the  phrenic  ganglion,  which  is  situ- 
ated just  below  the  diaphragm,  the  terminals  of  course,  perforating  the  dia- 
phragm to  reach  this  phrenic  or  diaphragmatic  ganglion  of  the  sympathetic- 
This  ganglion  of  the  sympathetic  is,  of  course,  connected  with  tne  solar  plexus. 
This  ganglion  sends  branches  to  the  hepatic  plexus,  and  also  sends  some  fila- 
ments to  the  inferior  vena-cava.  Of  course  its  function  as  a spinal  nerve  is  to 
supply  the  muscle  of  the  diaphragm.  From  the  left  nerve  branches  go  to  join 
the  solar  plexus,  but  there  is  no  gajrglia  formed.  Quain  substantiates  those 
points,  and  says  further  that  branches  reach  the  phrenic  in  the  neck  from  the 
middle  or  the  lower  sympathetic  ganglia,  some  branches  going  to  the  pericard- 
ium. And  that  from  the  right  nerve  were  branches  going  to  the  inferior  vena 
cava,  both  above  and  below  the  diaphragm,  and  that  branches  also  go  to  the  right 
auricle  of  the  heart.  Pansini,  according  to  Quain,  has  found  in  animals  that 
the  phrenic  plexus  of  the  diaphragm  is  participated  in  by  the  lower  three  inter- 
costal nerves.  You  will  see  that  the  purpose  is  to  associate  the  muscles  of  res- 
piration, the  abdominals,  intereostals  and  the  diaphragm  itself.  Quain  states 
further,  that  the  phrenic  may  have  a branch  from  the  hypoglossal  nerve  and 
from  the  5th  cervical  nerve.  Such  are  the  facts  in  relation  to  the  phrenic  and 
its  distribution.  When  we  examine  those  facts  in  the  light  of  Osteopathy,  it 
seems  certain  that  we  find  the  phrenic  significant  to  us  in  more  ways  than  one. 
You  see  from  what  I have  said  that  the  phrenic  is  connected  with  the  sympa- 
thetics ; first  with  the  middle  or  lower  sympatheties  in  the  neck ; next,  that  it 
receives  a filament  from  the  sympathetic  in  the  chest;  next,  that  it  perforates 
the  diaphragm  to  join  the  nerves  of  visceral  life,  those  on  the  right  running 
from  the  diaphragmatic  ganglion,  those  on  the  left  joining  without  the  inter- 
vention of  a ganglion.  You  notice  further  that  it  has  a couuei^tion  with  a cran- 
ial nerve — the  hypoglossal ; that  it  has  branches  connected  with  the  brachial 
plexus,  that  is,  from  the  .5th  cervical ; and  that  it  may  perhaps  join  with  the 
lower  three  intereostals,  but  I do  not  know  that  that  has  ever  been  shown  to 
be  true  in  man,  The  conclusion  is  obvious,  then,  from  what  we  know  of  the 
connection  of  nerves  in  different  parts  of  the  body,  both  sj'mpathetic  and  other- 
wise, that  if  any  of  these  sympathetic,  spinal  or  cerebral  nerves  were  diseased, 
the  disease  might  conceivably  be  extended  to  the  phrenic  and  affect  it,  and  that 
we  might  have  phrenic  symptoms  arising  from  these  other  troubles.  The  re- 
verse of  course  is  true,  and  that  any  of  these  structures  which  are  supplied  by 
the  sympatheties  or  these  other  nerves,  may  refiexly  affect  the  phrenic  nerve. 
You  have  seen  that  it  supplies  the  pericardium,  pleura  and  peritoneum,  that  it 
supplies  one  of  the  great  blood  vessels,  the  inferior  vena  cava,  and  sends 
branches  to  the  right  auricle  of  the  heart,  and  there  is  no  reason,  according  to 
mr  theory,  vvhy  disease  in  any  or  these  situations  might  not  affect  the  phrenic 
nerve,  and  you  might  have  symptoms  of  disease  in  the  phrenic  nerve.  So  that 


99 


our  theoretical  rule  is  certainly  a good  one,  for  it  will  work  both  ways,  either 
affecting  the  phrenic  nerve  or  the  other  structures  as  the  case  inaj'  be.  The 
importance  of  this  to  us  lies  in  the  fact  that  it  would  be  an  adjuvant  m the 
treatment  already  used.  It  is  one  more  path  by  which  we  can  influence  nen^e 
force.  We  have  certain  ways  of  reaching  the  abdominal  viscera  through  the 
splachuics  in  the  back ; we  might  have  a case  where  we  could  not  get  at  it  in 
that  region,  but  if  we  could  reach  the  trouble  through  the  phrenic,  we  would 
accomplish  the  desired  result.  As  I have  said,  these  facts  are  not  fully  demon- 
strated, but  it  is  a theory  which  I leave  for  your  consideration,  and  which  j’ou 
can  work  on  in  your  practice.  It  comes  to  us  as  another  key  to  unlock  the 
doors  of  sympathetic  life ; another  way  in  which  we  can  work ; another  tool 
in  our  hands. 

I wish  to  call  u^)  what  Dr.  Hilton  says  in  regard  to  the  phrenic  nerve: 
he  sets  out  very  clearly  why  it  is  that  it  perforates  the  diaphragm  and  is  dis- 
tributed on  its  lower  surface  rather  than  upon  its  upjier  surface.  He  shows 
that  were  it  distributed  to  the  upper  surface  the  nerves  would  then  be  im- 
pinged upon  by  the  lungs,  and  you  w ould  have  constant  interference  with 
nerve  force,  but  it  is  distributed  on  the  under  side  of  the  diaphragm  where  it 
is  removed  from  the  tendency  of  pressure  of  parts  above,  and  the  tendency  of 
the  force  of  gravitation  is  to  draw  away  the  stomach,  liver  and  spleen  from 
the  under  surface  of  the  diaphragm,  so  that  thei’e  can  be  no  interference  with 
the  plexus  situated  below  the  diaphragm.  Dana  makes  use  of  this  tendeuc\- 
of  gravitation  in  the  case  of  hiccoughs,  but  in  a somewhat  different  way.  That 
is,  he  states  that  it  has  a very  effective  action  in  hiccoughs.  He  places  the 
l^atient  on  a table  with  his  head  down  over  the  edge  of  the  table;  that  wmuld 
allow  the  thorax  to  arch  up,  and  the  action  of  gravitation  would  allow  the 
heavy  viscera  to  imxiinge  upon  the  under  surface  of  the  diaphragm,  and  it 
would  in  that  way  be  heliiful  in  stopxiiug  the  hiccoughs,  by  inhibiting  the 
nerves  of  the  jilexus.  Hilton  does  not  explain  it  so.  It  may  be  that  the 
stretching  of  the  thorax,  thus  extending  the  contracted  muscle  wmuld  by  its 
extension  send  an  imiinlse  back  over  the  nerve  and  quiet  the  si^asm.  I have 
not  heard  it  explained  why  the  drinking  of  cold  water  stops  hiccoughs,  but 
there  may  be  an  explanation  here  in  connection  with  the  s^  injiathetics:  that 
the  action  of  the  cold  water  may  be  such  as  to  for  a while  inhibit  the  action 
of  the  sympathetics,  sending  an  action  reflexly  back  to  the  ijhrenic  from  its 
sympathetic  conuectious,  and  thus  causing  the  sptasin  of  the  hiccoughs 
to  be  released.  So  that  in  our  w'ork  uijou  the  abdominal  viscera  we  may 
avail  ourselves  of  the  advantage  of  wark  in  the  neck  on  the  phrenic.  Dana 
states  that  he  treats  diaphragmatic  palsy  by  electricity  aiaplied  to  the  neck. 
He  says  there  is  a motor  area  in  the  neck  wTiich  is  readily  affected  by  the 
electric  current.  So  that  it  no  doubt  corresiaonds  with  the  work  we  do  when 
we  bring  jaressure  directly  uiaou  the  jahi’enic  nerve. 


100 


I wish  to  qnote  from  Dr.  Jacobson  along  this  line  as  follows:  “Another 

reason  for  the  phrenic  nerves  traversing  the  diaphragm,  4ind  breaking  up  into 
branches  on  its  under  surface  may  be  taken  to  enable  them  to  come  into  com- 
munication with  the  sympathetic  or  visceral  nerves  of  the  abdomen.  From 
this  communication  branches  are  given  to  the  hepatic  and  solar  plexuses,  and 
the  inferior  vena  cava.  Everyone  knows  the  value  of  active  exercise  when 
certain  abdominal  viscera  are  torpid  iu  the  performance  of  their  functions,  e. 
g.,  in  constipation,  biliousness,  etc.  The  perforation  of  the  diaphragm  by 
the  phrenic  and  its  communication  with  the  abdominal  sympathetics  must  bring 
the  brain  and  spinal  cord,  the  diaphragm  and  abdominal  muscles,  so  important 
in  active  respiration,  into  intimate  association  with  the  subjacent  viscera.’’  So 
says  Dr.  Jacobson.  Hence,  we  see  that  we  can  go  farther,  and  say,  that  since 
the  brain  and  cord  are  thus  brought  into  connection  through  the  phrenic  with 
the  sympathetics  and  with  abdominal  sympathetic  life,  and  since  it  must  send 
certain  impulses  along  those  nerves  and  thus  affect  abdominal  sympathetic  nerve 
life,  there  is  no  reason  why  the  reverse  may  not  be  true.  And  why  may  we  no 
affect  the  brain  and  cord  by  working  back  from  the  sympathetics,  and  more 
particularly  when  there  is  a lesion,  because  manipulation  must  tend  toward 
the  normal?  You  would  manipulate  the  phrenics ; the  abnormalities  would  be 
affected,  you  would  affect  the  phrenic,  and  thus  be  more  likely  to  affect  other 
nerves  which  have  under  control  that  which  has  become  abnormal.  There  is 
no  reason,  according  to  our  theory,  why  we  would  not  tone  up  the  whole  mech- 
anism of  respiration,  especially  the  muscular  respiration,  since  it  is  in  connec- 
tion with  the  phrenic  nerve  and  with  the  abdominal. 

I emphasize  once  more  what  I have  said  frequently  before — that  work 
upon  nerve  terminals  will  affect  the  nerve  itself  and  will  affect  the  center  from 
which  it  comes.  I think  that  position  taken  by  Osteopaths  is  impregnable. 
I wish  to  quote  from  Dr.  Hilton  in  a case  of  pain  in  the  knee,  where  the 
trouble  was  in  the  hip,  which  the  Osteopath  often  meets,  and  which  shows  us 
that  doctors  are  not  always  in  the  dark  in  their  diagnosis  of  these  cases.  Dr. 
Hilton  says:  “Again,  we  find  some  patients  with  hip-joint  disease  suffering 

from  pain  in  the  knee.  Xowq  although  the  disease  does  not  lie  there,  we 
know  that  the  pain  can  be  relieved  by  a belladonna  plaster,  or  strong  hem- 
lock poultices,  or  fomentations  applied  over  the  knee  joint;  thus  acting  upon 
the  nerves  of  the  hip  joint  through  the  medium  of  those  which  are  spread 
over  the  knee-joint.”  He  has  made  the  point  previously  that  the  nerves  of  a 
joint  sni)ply  also  the  skin  over  the  joint  and  over  the  insertion  of  the  muscles 
which  move  the  joint.  So  you  have  one  nerve  going  to  a joint,  to  its  muscles 
and  to  the  skin  over  those  muscles.  We  see  that  the  therepeutic  value  of 
work  upon  nerve  terminals  has  been  recognized  and  used  long  before  this. 
Our  method  is  peculiar  in  this:  that  it  works  upon  nerve  terminals  exclusive- 
ly by  manipulation  and  its  effects.  Perhaps  some  of  you  have  heard  of  cei'- 


101 


tain  exercises  for  troubles  of  the  stomach,  bowels,  liver,  etc.  It  is  recom- 
mended that  the  patient  who  has  torpid  liver  should  every  morning  get  dovm 
on  all  fours,  that  is,  keeping  the  legs  stiff  and  walking  on  the  hands  and  feet, 
and  run  briskly  around  the  room.  That  if  he  would  do  that  it  would  ijress 
the  liver  and  squeeze  it  like  a sponge  and  could  not  help  but  stir  up  the 
torpid  circulation  from  the  portal  system.  There  is  another  stooping  motion 
given  in  which  the  patient  keeps  the  back  straight,  bends  his  knees  and 
allows  his  body  to  sink  down  straight,  then  he  can  bend  so  that  the  shoulders 
push  against  the  knees.  You  will  notice  that  it  is  a sort  of  pumping 
motion,  it  will  stretch  the  spine  and  kneed  the  bowels  and  abdomen  thor- 
oughly. Often  this  may  be  of  practical  use,  and  you  might  suggest  it  to 
patients  with  similar  troubles.  ^!ow,  what  would  be  the  effect  in  such  a 
case?  I do  not  think  it  would  be  simply  local  in  pumping  the  blood  through 
the  abdomen  and  its  contents.  I think  that  the  tendency  there  would  be  to 
affect  the  nerve  supply,  if  our  work  and  our  theoiy  go  for  anj’thiug,  and  af- 
fect generally  the  abdominal  nerves,  and  through  them  the  centers,  which 
may  themselves  be  in  an  abnormal  condition.  The  tendency  continually  tow- 
ard the  normal  would  tell  us  why  work  upon  the  abdomen  should  affect  cere- 
bral centers  and  thus  restore  them  to  the  normal.  We  had  quite  a marked 
case  in  Chicago  some  time  since.  A lady  patient  told  Dr.  Sullivan  that  she 
had  been  treated  by  an  Arabian  doctor,  who  adopted  a queer  method.  She 
said  he  had  directed  her  to  fix  her  mind  upon  the  point  in  view  every  day  at 
a definite  time,  and  he  had  given  her  particular  instructions  as  to  how  it 
should  be  done,  and  she  said  she  was  perfectly  restored  from  constipation. 
The  explanation  given  was  that  by  thus  working  on  the  mind  this  doctor  had 
finally  led  his  patient  to  gain  control  of  the  cerebral  center  which  has  to  do 
with  these  functions. 

I have  already  examined  the  neck  before  you,  and  shown  you  how  to  treat 
it.  I think  we  are  ready  to  take  up  the  head.  I inaj-  say  in  passing  that  it  is 
my  idea  to  first  go  over  the  body  piece  by  piece,  give  you  the  examination  and 
treatment  for  different  pieces  of  the  body.  That  is  a piecemeal  way  to  do.  but 
I think  it  will  give  you  an  analysis  of  the  whole.  After  I have  done  that  we 
shall  have  a synthesis,  and  I will  take  up  special  diseases  and  show  you  how 
to  examine  and  treat  the  case,  combining  different  movements  and  treatments 
according  to  circumstances. 

II.  Landmarks  of  the  Head.  Holden  notes  the  following:  That  the 

scalp  is  '^ery  tough  and  dense  on  account  of  its  close  connection  with  the 
aponeurosis.  That  its  density,  therefore,  often  obscures  the  growth  of  tumors 
upon  the  cranium.  A tumor  beneath  the  aponeurosis  may  very  readily  be 
confused  with  a growth  from  the  scalp  itself  or  from  the  brain,  and  in  general 
such  tumors  are  firm  and  resisting.  Other  tumors  that  are  above  are  very 
readily  movable,  and  when  they  are  movable  I believe  the  point  is  general 


102 


that  they  are  not  so  serious.  The  supra- orbital  artery  is  felt  pulsing  just 
above  the  notch.  You  all  know  where  the  supra  orbital  notch  is,  at  the 
junction  of  the  inner  and  middle  third  of  the  supraorbital  arch.  It  runs 
thence  up  over  the  forehead,  and  by  carefully  feeling  you  will  be  able  to  note 
the  pulse. 

The  temporal  artery  is  felt  an  inch  and  a quarter  behind  the  external  an- 
gular process  of  the  frontal  bone.  The  occipital  artery  is  felt  near  the  middle 
of  a line  drawn  from  the  occipital  protuberance  to  the  mastoid  process.  The 
posterior  auricular  artery  is  felt  pulsing  near  the  apex  of  the  mastoid  process. 
I think  it  is  a very  good  way  to  train  the  touch  to  feel  for  the  different  art- 
eries at  different  places. 

It  is  said  that  the  skull  cap  is  rarely  exactly  symmetrical.  The  promi- 
nence of  the  frontal,  parietal  and  occipital  portions  of  the  cranium  is  a partial 
indication  of  the  development  of  those  respective  parts  of  the  brain,  and  it  is 
stated  a good  way  to  measure  the  relative  proportions  is  to  pass  a string  from 
one  external  auditory  meatus  to  the  other,  first  over  the  frontal,  then  over 
the  parietal,  and  then  over  the  occipital  eminences,  and  thus  you  can  get  an 
idea  of  the  comparative  bulk  of  these  lobes  of  the  brain,  because  it  is  said  the 
lobes  of  the  brain  correspond  in  general  to  these  parts. 

The  anterior  fontanelle  in  the  infant  you  are  all  familiar  with.  It  should 
be  carefully  noted  whether  the  condition  is  a hill  or  a hollow.  Of  course 
normally  it  is  even.  If  it  is  a hill  it  will  indicate  too  much  cerebral  fluid 
present,  as  in  hydro-cephalus.  But  if  there  is  a wasting  of  the  fluids  of  the 
body,  as  in  diarrhea,  you  may  have  a hollow  there,  formally  the  rate  of 
pulse  beat  may  be  counted  at  the  fontanelle  of  a sleeping  infant.  The  frontal 
sinuses  do  not  gain  their  normal  size  until  after  puberfis".  The  absence  of 
them  is  not  indicative  of  much  because  they  grow  inside,  or  if  they  are  very 
Ijrominent  it  naay  be  simply  a heaping  up  of  the  bone,  and  a degeneration. 

The  mastoid  process  is  filled  with  air  cells,  lined  with  mucous  membrane, 
and  it  may  develop  as  other  mucous  membranes  do,  a catarrhal  condition  and 
lead  to  suppuration.  The  occipital  protuberance  is  the  thickest  part  of  the 
skull,  about  three-quarters  of  an  inch  thick.  The  part  at  the  temple  is  the 
thinest,  and  may  be  as  thin  as  parchment,  it  is  stated.  The  external  auditory 
canal  runs  slightly  foward  and  inwai’d,  hence  in  examining  you  must  pull  the 
auricle  backward  and  upward. 

Marks  for  the  face.  The  three  points  of  the  three  terminations  of  the 
fifth  nerve  are  at  the  supra- orbital,  infraorbital  and  mental  foramina,  respect- 
ively. A line  passed  down  from  the  supra-orbital  foramen,  passing  between 
the  two  bicuspids,  will  pass  over  these  three  foramina.  Of  course  nerve  ter- 
minals are  important  with  us,  and  we  get  an  important  effect  on  the  fifth 
nerve  by  working  on  these  terminals.  The  two  lower  foramina  look  toward 
the  nose. 


103 


III.  Examination  of  the  Head  and  Face.  Of  course  I do  not  need  to 
state  to  you  that  the  examination  of  the  head  and  its  parts,  embodying  as  it 
does,  the  eye,  ear,  nose  and  throat,  upon  any  one  or  two  of  which  some  men 
spend  a lifetime  of  study  and  work,  lecture  and  treatment  can  be  encompassed 
by  a few  lectures.  We  all  recognize  the  importance  of  the  subject.  Howev- 
er, I think  we  can  take  a general  view  of  this  subject  now  in  a few  lectures 
and  depend  upon  later  lectures  and  later  experiences  to  enlarge  upon  our 
knowledge.  The  Osteopath  has  good  success  with  troubles  of  the  head,  brain 
troubles,  diseases  of  the  eye,  ear,  nose  and  throat,  and  diseases  of  the  face. 
His  treatment  is  very  simple,  being  for  the  greater  part  in  the  neck.  Troubles 
of  the  eye  and  the  ear  are,  as  you  know,  closely  associated  with  the  superior 
cervical  ganglion  of  the  sympathetic  and  with  the  various  vertebrae.  Dislo- 
cations of  these  vertebrae  are  very  important.  The  atlas  will  affect  the  ear, 
and  the  atlas  and  upper  cervical  will  affect  the  eye.  So  that  in  any  examina- 
tion that  you  make  of  the  head  and  its  parts  you  must  do  it  in  connection 
with  the  neck.  Please  remember  that  the  separation  of  these  subjects  has 
been  merely  for  convenience,  but  that  they  must  all  work  together.  For  in- 
stance, you  may  find  a catarrhal  condition  of  the  head  where  the  cause  may 
be  entirely  in  the  neck.  You  may  have  a case  of  insanity  where  the  trouble 
is  wholly  in  the  neck.  With  these  remarks  I think  you  will  note  the  im- 
portance of  examining  the  neck  and  treating  it  in  conjunction  with  head 
troubles. 

In  examining  a patient  at  any  time  you  should  note  the  size  and  shape 
of  the  head;  you  should  look  for  the  presence  of  tumors  or  ulcerations  upon 
the  scalp  or  beneath  it,  and  also  carefully  examine  to  see  if  the  head  is  bald. 
Always  notice  the  face,  as  it  is  a great  indicator  of  disease;  notice  the  counte- 
nance; the  expression.  You  will  frequently  come  across  in  medical  literatui-e 
the  fact  that  the  patient  has  a worried  expression.  Your  patient  will  some- 
times wear  an  anxious  expression.  Different  diseases  affect  the  countenance 
differently,  and  you  will  often  meet  this  anxious  expression  of  countenance? 
so  that  is  an  important  indication,  as  is  also  the  complexion.  You  have  all 
seen  the  comj)lexion  of  jaundice;  stomach  trouble  will  have  its  effect  upon  the 
complexion;  certain  diseases  of  the  genitals  will  cause  eruptions  on  the  face. 
I'hese  things  you  will  bear  in  mind.  In  looking  at  the  face  always  note  the 
lower  jaw.  It  is  especially  important  from  the  Osteopathic  point  of  view. 
It  may  be  slipped  backward  or  forward  or  it  may  be  deviated  from  one  side, 
and  in  being  so  may  cause  a tightening  of  the  ligaments  of  the  jaw  causing 
serious  results.  It  may  affect  the  ear,  or  it  may  have  something  to  do  with 
neuralgia  of  the  fifth  nerve. 

lu  looking  at  the  eye,  always  notice  the  conjunctiva,  whether  or  not  it  is 
engorged  with  blood,  whether  or  not  it  is  yellow,  whether  there  is  any  growth 
upon  it,  or  aiij’  abnormality  whatever  concerning  it.  Note  whether  or  not  tlie 


104 


eye  is  brilliant;  in  some  it  is  dull.  -4.11  of  these  points  should  be  significant  to 
you.  There  may  be  growths  upon  the  eye,  pterygium,  winch  have  l>een  suc- 
cessfully treated  by  Osteopaths.  You  may  find  cataract:  we  have  had  some 
success  in  curing  this  also  by  Osteopathy.  It  is  vvell  in  examining  a patient  to 
note  whether  or  not  the  iris  reflex  can  be  obtained.  Dr.  Harry  Still  always 
says  there  is  considerable  hope  for  an  eye  if  3'ou  can  find  upon  examination 
that  the  ins  will  readily  dilate.  He  just  taps  the  closed  eye.  putting  one  finger 
upon  it.  tapping  three  or  four  times  gentl}-  with  another ; if  that  has  caused  the 
iris  to  dilate  you  will  know  that  the  reflex  is  intact.  You  can  also  determine 
this  by  shutting  off  the  light  and  then  instantly  turning  it  on.  the  reflex  being 
manifest  in  the  same  way.  You  should  in  your  examination  of  the  eye  note 
what  is  the  color  of  the  mucous  membrane.  A very  pale  color  will  indicate  an 
absence  of  sufficient  nutriment;  absence  of  blood  supply.  In  anemia  the  mu- 
cous membranes  of  the  whole  body  are  pale,  hence  you  will  want  to  examine 
the  eye  in  health  to  acquaint  yourselves  with  these  phenomena.  In  examining 
the  eye  we  have  to  turn  back  the  lids,  the  under  lid  is  very  readily  turned  back 
and  down,  and  you  can  examine  it  and  notice  if  there  is  any  foreign  body  upon 
it.  The  upper  lid  is  not  quite  so  readily  turned  back.  You  can  do  it  with  a 
pencil,  or  you  can  push  it  right  up  and  back.  Note  the  meibomian  glands  and 
note  whether  or  not  there  are  any  granulations  or  any  foreign  growths.  It  will 
be  well  for  you  to  note  whether  or  not  the  tonicity  of  the  muscles  about  the  eye 
is  normal,  holding  the  puncta  lachrymala  against  the  globe  of  the  eye.  A 
loosening  of  a ransele  may  cause  the  flowing  of  tears  over  the  face,  or  some 
growth  may  obstruct  the  duct  producing  the  same  result,  and  you  want  to 
know  whether  or  not  it  is  simply  a loosening  of  the  muscles  or  some  obstruc- 
tion in  the  duct.  You  may  in  looking  at  the  eye  discover  a foreign  body. 
Sometimes  you  cannot  see  it.  sometimes  you  have  to  look  obliquely  across  the 
cornea  of  the  eye.  It  may  be  stuck  on  the  cornea  and  you  will  have  to  look  at 
it  by  an  oblique  light,  so  as  see  whether  the  surfaces  are  clear.  Looking  at  it 
obliquely  will  also  enable  you  to  see  pterygiums,  although  these  are  generally 
readily  seen  by  looking  at  it  directly.  The  presence  of  dead  lashes  is  a suf- 
ficient cause  of  disease ; you  can  have  quite  a sore  eye  merely  on  account  of 
dead  lashes  being  left  in  the  lids.  They  should,  1 think,  be  regularly  pulled 
out  every  once  in  a while,  and  should  be  gently  tried  to  see  whether  or  not  they 
will  come  out.  It  is  said  that  if  a person  will  keep  them  removed  he  is  not  apt 
to  have  trouble  with  his  eyes.  When  they  have  become  lifeless  you  will  see 
little  black  points  on  the  eye-lids.  It  is  said  a ftilliiess  under  the  eye  is  indica- 
tive of  dropsy.  The  presence  or  absence  of  a ring  about  the  eye  is  also  indica- 
tive of  the  general  health. 


105 


LECTUEE  XVII. 

I spoke  last  time  of  tbe  phrenic  nerve,  showing  how  it  has  ^‘onnection 
with  the  sympathetic,  and  advancing  the  theory  that  very  possibly  importatant 
results  might  be  obtained  Osteopathically  by  working  upon  this  nerve  for  the 
sake  of  influencing  its  connections,  calling  to  your  attention  the  fact  that  it 
supplied  the  peritoneum  and  pericadiuni,  send  braches  to  the  inferior  vena 
and  a branch  to  the  right  auricle  ot  the  heart.  That  it  ahso  connected  with  the 
sympathetics  below  the  diaphragm  and  thus  had  very  important  connections 
with  visceral  life.  That  it  also  connected  with  a cranial  nerve,  the  hypoglos- 
sal, and  with  spinal  nerves,  viz.,  the  5th  cervical,  and  that  in  some  animals 
connection  had  been  noted  between  the  phrenic  and  three  lower  intercostal 
nerves.  This  connection  with  the  muscles  of  respiration  is  to  cause  them  to 
work  in  conjunction.  That  is  the  theory  supported  by  the  quotation  from  Dr. 
Jacobson — that  work  upon,  or  exercises  that  would  influence  the  abdominal 
viscera  would  thus  have  an  influence  upon  the  brain.  It  seems  likely  that  by 
work  upon  these  parts  we  can  get  an  influence  over  the  parts  affected  and  thus 
perhaps  reach  brain  centers  and  gain  an  influence  over  them.  I noted  also  the 
value  of  such  exercises  as  stooping,  those  which  would  bring  a squeezing 
motion  upon  the  liver,  intestines  and  stomach,  and  showed  how  it  might 
through  these  nervous  connections  affect  the  parts  which  were  at  fault.  I 
then  explained  certain  points  concerning  landmarks  about  the  head  and  face, 
and  spoke  on  the  subject  of  how  to  examine  the  head,  face  and  its  parts.  I 
wish  to-day  to  continue  that  line  of  thought,  giving  particular  attention  to  the 
eye. 

I.  OSTKOPATHic  Points  Concerning  THE  Eye  : — We  are  aware  that  the 
nerve  supply  of  the  eye,  which  is  itself  a nervous  organ,  is  various  and  impor- 
tant, and  we  shall  see  later  in  the  lecture  that  we  have  quite  a broad  field  upon 
which  to  work  to  reach  the  eye.  I have  already  given  you  some  centers  for 
the  eye,  and  have  already  spoken,  in  considering  the  neck,  about  the  blood 
supply  to  the  head  and  its  parts,  and  it  is  also  of  course  veiv  important  to  us. 
We  get  our  effect  upon  it  through  the  nerves:  the  superior  cervical  ganglion 
is  the  chief  center  upon  which  we  work  to  affect  the  eye.  I have  seen  a ease 
of  “blood  shot”  eye,  as  we  commonlj"  call  it,  cured  by  treating  in  the  superior 
cervical  region  ; simply  by  inhibiting  the  action  of  the  sympathetics  at  that 
place.  So  you  see  the  superior  cervical  ganglion  has  an  important  control 
over  the  mechanism  of  the  blood  supph'.  We  probably  affect  it  through  the 
ascending  branch  to  the  carotid  and  cavernous  plexuses,  and  no  doubt  also 
through  the  connection  which  it  has  with  the  fifth  nerve — the  fifth  nerve  hav- 
ing important  vaso-motor  fibres  to  the  eye.  Quain,  in  his  anatomy  describes 
branches  from  the  cavernous  plexus  which  run  to  the  cerebral  and  ophthalmic 
arteries,  forming  a secondary  plexus  about  them,  and  from  them,  he  says, 
some  branches  go  to  the  eye-ball  and  form  a plexus  of  the  sympathetic  in  the 


eye-ball  itself.  Hence,  you  see,  we  have  a very  important  and  direct  connec- 
tion with  the  sympathetic  through  the  superior  cervical  ganglion,  through  its 
ascending  branches,  and  this  terminal  sympathetic  plexus  in  the  eye-ball 
The  ciliary  ganglion  is  also  important  in  relation  to  our  work  upon  the  eye. 
It  has  connection  with  the  third  and  fifth  cranial  nerves  and  with  the  sympa- 
thetics.  The  third  and  fifth  nerves  are  important,  as  you  will  see  later  when 
I shall  take  that  up  more  in  detail.  Concerning  the  ciliary  ganglion,  Quain 
says:  “The  ciliary,  opthalmic  or  lenticular  ganglion  serves  as  a center  for 

the  supply  of  nerves,  motor,  sensory  and  sympathetic,  to  the  eye-ball.”  Thus 
we  have  a center  upon  which  we  may  work.  Further,  he  says,  “The  sympa- 
thetic root  is  a very  small  nerve  which  emanates  from  the  cavernous  plexus.” 
So  the  ciliary  ganglion  gets  its  sympathetic  supply  for  the  eye  from  the  cavern- 
ous plexus.  The  ciliary  ganglion  lies  at  the  bottom  of  the  orbit  between  the 
rectus  muscle  and  the  optic  nerve.  There  is  a treatment  which  w^e  frequently 
give  the  eye,  not  a tapping,  but  a pressure  of  the  eye  back  into  its  socket ; and 
I think  the  effect  there  must  be  upon  the  cilliary  ganglion,  and  since  it  is  con- 
nected with  the  third  and  fifth  nerves,  we  could  undoubtedly,  if  there  were  ab- 
normalities, get  an  effect  upon  those  nerves.  Thus,  working  in  this  way  we  might 
affect  the  third  nerve  and  tone  up  the  muscular  mechanism  of  the  eye,  or 
working  in  this  way  indirectly  upon  the  fifth  nerve,  w^e  might  tone  up  the 
nutrition  of  the  eye.  Thus  you  see  by  pressure  we  have  reached  not  a nerve, 
but  a center,  and  the  reverse  is  clearly  true  according  to  our  theory,  that  we 
might  work  upon  terminals,  as  for  instance,  the  terminals  of  the  fifth  nerve 
w'hich  are  readily  reached  in  the  face,  and  in  that  way  get  an  effect  upon  this 
ciliary  ganglion  which  is  connected  with  the  fifth  nerve.  Or,  by  working  as 
we  do,  through  the  superior  cervical  ganglion  to  reach  the  third  nerve,  wm 
might  have  an  effect  upon  the  ciliary  ganglion,  of  course  through  its  sympa- 
thetic connection.  This  will  serve  to  show  you  how  closely  connected  is  all 
this  nerve  supply  to  the  eye.  One  is  quite  dependent  upon  the  other,  and  in 
affecting  one  you  affect  the  other,  provided  it  is  in  need  of  treatment.  Thus 
you  see  that  by  workiug  ou  this  theory  you  can  affect  not  only  sympathetic 
life,  but  sensation  and  motion  of  the  eye,  since  these  nerves  send  branches  to 
the  eye.  A little  further  with  regard  to  the  third  nerve  and  its  connection 
with  the  eye  ball:  It  innervates  all  the  muscles  of  the  eye  ball,  as  you  know, 

except  the  external  rectus  and  superior  oblique.  ‘ Through  the  ciliary  gang- 
lion it  also  rules  the  sphincter  of  the  iris.  Howell’s  Text  Book  states  that 
there  are  fibers  antagonistic  to  this  motor  occuli  from  the  ciliary  ganglion, 
which  constrict  the  iris  and  lessen  the  aperature  of  the  pupil.  The  antago- 
nistic fibers  to  this  motor  occuli  come  from  the  third  ventricle,  through  the 
bulb,  the  cervical  cord,  the  anterior  roots  of  the  upper  dorsal  nerves,  the 
upper  thoracic  ganglion  and  the  cervical  sympathetic  cord,  and  thus  that  it 
joins  tire  ophthalmic  division  of  the  fiftli  nerve,  passing  through  its  nasal 


107 


branch  and  its  long  ciliary  branches  to  the  iris.  These  antagonistic  fibers,  of 
course,  must  be  dilators.  Thus  from  the  motor  occuli  you  get  the  motor 
fibers  to  the  sphincter  of  the  iris  and  from  the  region  I have  just  explained 
you  get  the  dilator  fibers  of  the  iris.  Hence,  we  dilate  the  iris  by  stimulating 
the  superior  cervical  ganglion  or  stimulating  in  the  upper  dorsal  region,  more 
particularly  the  latter.  Quin,  in  speaking  of  fibres  from  the  cervical  gang- 
lion, notes  these  centers;  dilator  fibers  arising  from  the  1st,  2nd,  and  .3d  doi  - 
sal  nerves,  then  passing  upward  in  the  ascending  branch  of  the  superior  cer- 
vical ganglion,  reach  the  Gasserian  ganglion,  and  the  eye  through  the  first 
division  of  the  fifth  nerve  and  the  long  ciliary  nerves.  He  also  says  in  par- 
enthesis that  it  is  stated  by  many  observers  that  the  dilator  fibers  are  con- 
tained also  in  the  7th  and  8th  cervical  nerves.  Motor  fibers  run  from  the 
higher  four  or  five  dorsal  nerves.  Thus  you  see  along  the  cervical  region, 
from  the  superior  cervical  ganglion  down  as  low  as  the  6th  dorsal  you  may 
get  an  important  effect  upon  the  eye. 

Concerning  the  fifth  nerve,  and  its  connection  with  the  eye  ball,  I have 
already  noted  its  connection  with  the  ciliary  mechanism ; that  there  are  dilator 
branches  from  the  cervical  and  upper  dorsal  through  the  nasal  branch  of  the 
fifth,  and  that  it  has  connection  with  the  Gasserian  ganglion.  The  ophthalmic, 
or  first  division  of  the  fifth  nerve,  which  is  sensory  in  function,  joins  with 
branches  from  the  sympathetic  derived  from  the  cavernous  plexus.  This  nerve 
supplies  the  lachrymal  glands,  the  conjunctiva  of  the  lids  and  of  the  eye  ball, 
and  the  skin  about  the  lid  and  the  face  of  that  part.  The  fifth  nerve  is  also 
very  important  in  the  nutrition  of  the  eye,  the  face,  and  different  parts  of  the 
head.  Green’s  Pathology  notes  the  fact  that  upon  section  of  the  fifth  nerve 
keratitis  or  inflammation  of  the  cornea  arises,  followed  by  ulceration  Kirke 
makes  the  same  statment,  and  says  further  that  the  disease  may  progress  so 
far  as  to  destroy  the  whole  eye-ball.  Kirke  also  states  that  in  the  case  of  the 
fifth  nerve,  the  fact  that  there  are  trophic  fibers  in  it  is  proven  by  experiments 
of  Meissner  and  Buttner,  who  found  that  division  of  the  innermost  fibers  is 
most  potent  in  producing  decay.  Howell’s  Text  Book  states  that  vaso-dilator 
fibers  for  the  face  and  mouth  are  found  in  the  cervical  sympathetics ; that  they 
leave  the  cord  at  the  second  to  the  fifth  dorsal ; that  they  connect  with  the  fifth 
nerve  by  passing  from  the  superior  cervical  ganglion  to  the  Gasserian  ganglion. 
That  other  dilator  fibers  for  the  skin  and  mucous  membrane  of  the  mouth  and 
face  seem  to  arise  in  the  fifth  nerve  itself,  also  some  in  the  nerve  of  VVrisberg. 
He  states  further  that  excitation  of  the  cervical  sympathetic  causes  constriction  ; 
excitation  of  the  thoracic  sympathetic,  dilation  of  the  retinal  arteries.  Thus 
you  see  that  working  from  the  cervical  sympathetic,  getting  an  influence  along 
the  path  of  the  fifth  nerve,  you  have  a vaso  motor  effect  upon  the  retina.  So 
you  have  not  only  trophic  but  vaso-motor  fibers  in  the  fifth  nerve,  supplying 
the  eye.  Quain  slates  further  that  the  original  fibers  leaving  the  sympathetic 
at  the  superior  cervical  ganglion  pass  to  the  ganglion  of  gasser  and  to  the  eye 


108 


from  the  ophthalmic  branch  of  the  fifth  through  the  gray  root  of  the  opthalmie 
ganglion  and  the  ciliary  nerves.  Almost  all  of  the  fibers  of  the  anterior  part 
of  the  eye  are  found  in  the  fifth  nerve,  hence,  you  can  readily  see  the  great 
importance  that  the  fifth  nerve  bears  to  Osteopathic  work  upon  the  eye,  because 
there  is  hardly  any  trouble  in  the  eye  which^inay  not  be  influenced  through  the 
nutrition,  and  such  troubles  are  readily  within  the  reach  of  the  Osteopath. 

Taking  into  consideration  the  facts,  then,  we  note  tirst,  that  the  eye  is 
readily  reached  by  the  Osteopath  in  two  ways ; through  its  blood  supply,  and 
through  its  nerve  supply.  We  note  further  that  the  chief  points  at  which  the 
Osteopath  works  to  affect  the  eye  are  the  third  nerve,  the  fifth  nerve,  the  su- 
perior cerv'cal  ganglion,  the  upper  dorsal  region,  and  also  the  ciliary  ganglion  ; 
that,  as  I noted  in  the  beginning,  the  superior  cervical  ganglion  is  the  most 
important  point  upon  which  we  work  in  treating  the  eye,  since,  as  you  have 
seen,  it  is  connected  with  the  third  and  fifth  nerves,  and  also  with  the  ciliary 
ganglion.  Also  that  through  it  you  get  an  effect  upon  the  iris,  upon  muscles, 
and  upon  nutrition  and  sensation  in  general.  So  that  the  Osteopath  certainly 
is  not  lacking  for  means  of  reaching  the  eye. 

We  note  further  that  there  is  a constrictor  center  for  the  iris  in  the  ciliary 
ganglion  and  in  the  superior  cervical  ganglion ; that  there  is  also  a dilator  cen- 
ter in  the  upper  dorsal  region  and  in  the  superior  cervical  ganglion.  That  is, 
dilator  center  for  the  ins.  That  is  something  that  might  be  a little  confusing, 
that  in  the  superior  cervical  ganglion  you  may  have  both  a constrictor  and 
dilator  center  for  the  ins.  However,  Dr.  McConnell  states  that  we  may  con- 
tract the  iris  by  working  at  the  upper  cervical  region,  and  that  we  dilate  it  by 
working  down  at  the  second  and  third  dorsal.  That  has  been  our  experience, 
and  although  there  seems  to  to  be  a confusion  of  centers  there,  we  go  accord- 
ing to  the  results.  We  may  work  in  one  way  upon  the  fifth  nerve  by  treating 
the  superior  cervical  ganglion,  and  we  get  an  important  effect  upon  the  fifth 
nerve  by  working  upon  its  terminal  branches.  As  I pointed  out  to  you  at  the 
last  lecture,  the  terminal  branches  of  the  fifth  nerve  are  readily  pressed  upon 
at  the  supraorbital  and  infraorbital  foramina,  as  well  as  at  the  mental  foramen, 
and  since  we  have  shown  that  working  upon  terminal  fibers  is  an  important 
part  of  our  work,  and  that  through  them  we  can  gain  important  effects  upon 
connected  nervous  mechanisms,  I think  it  shows  that  we  have  a good  opportun- 
ity to  reach  and  effect  the  nervous  mechanism  of  the  eye  through  the  fifth 
nerve. 

I noted  also  at  the  last  lecture,  the  importance  of  examining  the  neck  in 
any  trouble  of  the  eye  or  part  of  the  head.  If  there  is  any  dislocation  of  the 
atlas  or  of  the  third  cervical,  these  points  are  particularly  significant  in  regard 
to  eye  troubles,  or  there  may  be  an  interference  at  the  inferior  maxillary  articu- 
lation— a slip  of  that  articulation,  impinging  from  fibers  of  the  inferior  maxil- 
lary division  of  the  fifth  nerve,  and  since  in  that  way  you  may  affect  the  whole 
nerve,  it  may  have  an  affect  upon  the  eye. 


109 


Byron  Robinson  quotes  from  Fox  that,  ‘‘Irritation  of  the  peripheral  end  of 
the  cervical  sympathetic  will  cause  a protrusion  of  the  eye  ball,  while  section 
will  cause  a sinking;  of  the  eye  ball.”  Dr.  McConnell  states  that  there  are 
fibers  which  aid  in  the  control  of  the  metabolism  of  the  retina  at  the  fouth  and 
fifth  dorsal,  and  the  strong  stimulation  of  the  sexual  organs  causes  dilation  of 
the  pupils  and  protrusion  of  the  eye  ball. 

II.  Further  Landmarks  in  Regard  to  the  Parts  of  the  Head  and 
Face. — According  to  Holden  we  notice  the  fbllowing  points:  You  will  readily 
feel  the  pulley  of  the  superior  oblique  muscle  by  pressing  the  thumb  just  un- 
der the  inner  edge  of  the  orbit.  The  seyenth  nerve  has  its  exit  from  the  cra- 
nium at  the  stylo-mastoid  foreman.  It  then  passes  forward  and  runs  into  the 
parotid  glands.  It  sends  branches  upward  to  the  temple,  toward  the  eye.  the 
cheek,  and  jaw.  The  parotid  duet  lies  on  a line  drawn  from  the  bottom  of  the 
lobe  of  the  ear  to  midway  between  the  nose  and  the  mouth,  and  empties  op- 
posite the  upper  second  molar  touth.  It  is  accompanied  by  a branch  of  the 
facial  nerve  supplying  the  buccinator  muscle.  The  pulsation  of  the  tempo lal 
artery  may  be  felt  between  the  ridge  of  the  zygoma  and  the  anterior  part  of  the 
ear.  And  it  is  said  that  that  is  a very  convenient  place  to  feel  the  pulse  of  a 
sleeping  patient.  The  facial  artery  is  very  important  in  our  work.  It  passes 
over  the  inferior  maxillary  bone  at  the  anterior  edge  of  the  masseter  muscle  and 
also  at  the  side  of  the  nose  high  up.  The  coronary  arteries  are  readily  felt  by 
placing  the  finger  just  beneath  the  lip  against  the  mucous  membrane ; you  can 
feel  them  pulsate  on  the  inner  side  of  the  upper  lip  and  on  the  inner  side  of  the 
lower  lip.  The  facial  vein,  instead  of  taking  a tortuous  course  to  follow  the 
artery,  runs  directly  from  the  inner  angle  of  the  eye  down  to  the  anterior  border 
of  the  masseter  muscles. 

III.  Exaaiination  op  the  Eye: — I took  this  subject  up  at  the  last  lecture, 
but  there  are  some  other  points  that  I wish  to  call  to  your  attention  in  examin- 
jng  the  eye,  An  unnatural  luster  of  the  eye  is  seen  inTevers.  An  unnatural 
brilliancy  is  often  found  in  consumptives.  A glassy  eye  in  children  shows  in- 
flammation of  the  mesenteric  glands,  and  if  it  is  accompanied  by  dark,  dry  lips 
and  tongue  and  great  restlesness,  it  shows  an  acute  inflammation  of  the  stoni- 
ache.  In  fevers  glassy  eyes  are  a sign  of  great  danger  or  of  some  serious 
change  about  to  occur.  Dull  eyes  are  noticed  in  febrile  conditions,  during  the 
catamenia,  in  catarrhal  and  other  affections.  Sunken  eyes  are  due  to  the  ab- 
sorption of  the  fatty  cushions,  and  indicate  some  loss  of  the  vital  fluids ; hem- 
orrhage or  some  exausting  disease.  Exophthalmiis,  that  is.  protrusion  of  the 
eye  ball,  when  not  congenital,  is  said  to  be  characteristic  of  Basedow’s  or 
Graves’s  disease. 

In  your  examination  of  the  eye  you  should  bear  in  mind  and  see  what  parts 
of  the  eye  are  affected,  whether  it  is  the  lid,  iris  or  eonjuctiva,  whether  it  is 
a change  in  the  ej’^e  ball,  whether  the  Sight  is  affected,  or  there  be  weakening  of 
the  nerves,  or  inflammation  of  the  eye.’^ 


IIU 


IV.  Treatjiknt  oP  THE  Eye  : — As  I have  saul,  the  treatmeut  of  the  eye 
Osteopathically  is  quite  a simple  matter.  There  are  certain  points  that  I will  go 
over  to  notice  how  we  treat  the  eye.  lu  the  first  placs,  as  I noted,  we  sometimes 
bring  direct  pressure  upon  the  eye.  We  simply  with  one  hand  press  gently  up- 
on the  eye  ball,  or  you  can  lav  your  thumbs  ou  it  and  press  downward.  In 
that  vvay,  as  I explained  to  you,  you  probably  have  an  effect  upon  the  cili- 
ary gauglion.  you  would  also,  of  course,  mechanically  excite  the  blood  supply 
by  pressure.  You  would  also  have  an  effect  through  this  pressure  upon  the  optic 
nerve,  since  all  these  parts  by  being  pressed  back  into  the  cavity  would  be  more 
or  less  impinged  upon.  I also  noted  that  we  sometimes  gently  tapped  the  eye, 
laying  one  finger  upon  the  eye.  and  with  another,  tapping  three  or  four  times 
very  gently.  The  idea  in  that  is  Dr.  Harry  Still  says,  to  shock  the  optic  nerve 
and  thus  stimulate  it.  Of  course  in  that  way  also  we  stimulate  the  sympa- 
thetic, aud  through  them  the  blood  supply.  We  frequently  in  livatment  of  the 
head  tap  upon  the  frontal  sinus,  not  very  hard,  for  troubles  with  a branch  of 
the  fifth  nerve  which  supplies  that  sinus,  and  from  it  you  might  have  a bad  ef- 
fect upon  the  eye,  causing  some  pain,  which  you  might  relieve  in  that  way.  We 
are  frequently  called  upon  to  treat  granulated  eyelids.  They  are  something 
that  are  readily  treated  bv  Osteopathic  means,  and  something  which  are  very 
distressing  to  the  eye.  We  just  wet  the  finger  with  a little  water  or  some  oil. 
sweet  oil  or  vaseline  and  press  it  under  the  edge  of  the  lid,  both  above  and  be- 
low, and  then  pressing  with  the  thumb  against  the  lid  upon  the  finger,  work 
with  the  thumb  and  finger  along  the  edge  of  the  lid,  and  in  that  way  you  stim- 
ulate the  local  blood  flow;  and  the  thickening  there  causing  the  granulations  is 
said  to  be  due  sometimes  to  a local  hypertrophy  of  the  conjunctiva,  or  some- 
times to  a stopping  of  the  ducts  of  the  Meibomian  glands.  In  thus  working 
you  would  stimulate  the  blood  flow  to  make  that  conjunctive  normal  or  you 
would  take  away  the  stoppage  of  the  ducts  of  the  glands.  Sometimes  the  se- 
cretion gets  thick  and  stops  up  the  duets.  I have  often  heard  Dr.  Hildreth 
speak  of  quite  a noted  case  of  granulated  eyelids  which  were  entirely  cured. 
He  said  that  Dr.  Still  explained  that  there  was  a stoppage  of  the  circulation, 
that  the  blood  had  to  make  some  use  of  the  nutriment  which  was  carried  there, 
and  instead  of  its  being  directed  normally  it  was  directed  abnormally  on  ac- 
count of  the  stoppage,  and  so  caused  these  abnormal  growths.  What  he  did, 
was,  as  I have  said,  to  free  the  circulation.  Of  course  in  any  treatment  of  the 
eye  we  must  work  over  the  superior  cervical  ganglion  to  get  our  effect  upon  the 
circulation. 

I spoke  about  points  at  which  we  can  reach  the  fifth  nerve.  Particularly 
in  work  upon  the  eye  we  work  at  the  supraorbital  notch  or  foramen,  here  at 
the  junction  of  the  inner  and  middle  third  of  the  arch.  Be  careful  to  free  that 
so  that  any  contraction  of  the  tissues  about  it  are  thoroughly  relaxed.  Then 
the  same  thing  should  be  done  below,  at  the  infraorbital  foramen.  'W'e  also 


Ill 


get  a termination  of  the  fifth  nerve  at  the  outer  angle  of  the  eye,  and  I always 
work  carefully  there  and  stimulate  that  branch  of  the  fifth  nerve.  There  is 
said  to  be  a terminal  branch  just  over  the  middle  of  the  eye  lid,  and  two  ter- 
minal branches  at  the  inner  canthus  of  the  eye  on  the  nose,  where  we  can 
readily  impinge  upon  them.  A terminal  branch  is  found  also  upon  each  side 
of  the  mid-line  of  the  forehead.  According  to  the  theory  that  we  can  work 
upon  nerve  terminals,  as  we  frequently  do,  to  gain  an  important  effect  upon 
the  connected  parts,  we  here  have  a number  of  terminal  branches  of  the  fifth 
nerve  which  we  could  certainly  intlueuce  in  that  way  to  restore  the  normal. 
Of  course  at  these  places  we  also  get  the  little  blocd  vessels,  here  at  the  inner 
canthus  and  at  the  foramina  and  free  them  in  our  treatment.  Anotlier  way 
that  Dr.  Harry  sometimes  employs  almost  exclusively  in  work  upon  the  eye 
is  to  have  the  patint  spring  the  mouth  open  while  you  hold  the  jaw;  the  idea 
being  to  free  the  blood  supply  through  the  carotids,  since  the  blood  supply  of 
the  eye  is  derived  entirely  from  the  internal  carotids,  and  it  is  a very  impor- 
tant point  in  relation  to  work  upon  the  eyes.  Of  course  we  must  not  forget 
the  point  I mentioned  in  regard  to  the  neck,  and  which  you  are  familiar  vdth; 
but  the  great  and  important  point  upon  which  we  work,  always  remember,  is 
the  superior  ganglion.  Thoroughly  relax  everything  and  remove  every  pres- 
sure which  may  affect  the  blood  flow.  I showed  you  how  to  inhibit  the  action 
of  the  cei'vical  sympathetic  by  holding.  Of  course  stimulating  would  be  the 
opposite — working  qaiickly  with  alternate  pressure  and  relaxation. 


LECTUEE  XVIII. 

At  the  last  lecture  I took  up  points  in  regard  to  the  eye,  giving  you 
’^arius  centers,  which  I need  not  repeat  here.  Also  I noted  the  importance 
of  the  ciliary  ganglion  in  connection  with  the  eye,  the  importance  of  the  thii-d 
nerve  in  relation  with  the  eye,  also  of  the  fifth  nerve  in  nutrition  of  the  eye 
and  jjarts  of  the  head  and  face.  Then  I brought  out  certain  points  of 
importance  to  us  as  Osteopaths.  I uoted  certain  landmarks  concerning  the 
head  and  face;  concluded  the  examination  and  took  up  the  treatmeut  of  the 
eye.  I wish  to-day  to  continue  our  consideration  of  points  about  the  head 
and  face. 

I.  Certaiu  centers  for  the  parts  of  the  head.  I have  already  mentioned 
some  in  previous  lectures.  Howell’s  Text  Book  states  that  the  cervical 
sympathetic  contains  vaso-constrictor  fibers  for  the  face,  the  eye,  the  ear,  the 
salivary  glands,  the  tongue,  and  perhaps  the  brain.  As  to  vaso-motor 
nerves  to  the  tongue;  the  lingual  and  glosso-pharjuigeal  nerves  contain  vaso- 
dilator fibers,  while  the  hypoglossal  and  sympathetics  contain  vaso-constric- 
tor fibers.  The  chorda  tympani,  as  already  noted,  is  the  vaso-dilator  of  the 
submaxillary  gland.  Quaiu  states  that  the  secretory  fibers  of  the  submaxil- 


112 


lary  giand  arise  mainly  from  the  second  and  third  dorsal.  Dana  states  that 
herpes,  Hushing,  pallor,  lachrymation  and  salivation  all  indicate  some  dis- 
turbance of  the  sympathetic  and  trophic  fibers  contained  in  tlie  fifth  nerve. 
Quain  states  fui'therthat  the  glosso -pharyngeal  nerve  thi'ongh  its  small  super- 
ficial petrossal  branch  furnishes  secretory  and  vaso-dilator  fibers  to  the 
parotid  giand. 

In  view  of  these  facts,  and  of  facts  which  I have  already  presented,  I 
wish  to  call  the  following  points  to  your  attention:  First,  that  you  have  al- 

ready been  shown  how  to  reach  and  treat  the  fifth  nerve,  the  cervical  synipa- 
thetic,  the  lingual,  which  is  a branch  of  the  facial,  and  the  glossopharyngeal. 
I have  brought  up  further  the  hypoglossal  nerve,  which  is  reached  by  the 
Osteopath  at  its  exit  fi-om  the  skull  at  the  anterior  condyloid  foramen,  and 
also  indirectly  by  the  treatment  of  the  superior  cervical  sympathetic  gangiiori. 
That  the  Osteopath  thus  controls  the  nerve  supply  of  all  parts  of  the  head 
practically,  and  through  the  nerve  supply  the  blood  supply  to  the  head,  gov- 
erning, as  he  does,  by  his  work  upon  the  neck,  the  blood  flow  to  all  parts  of 
the  head,  he  must  have  an  important  effect  upon  its  nutrition.  A further 
point  is  that  the  Osteopathic  work  is  very  simply,  and  is  made  up  largely  of 
treatment  in  the  neck,  particularly  at  the  superior  cervical  ganglion.  I say 
very  sinix^le,  because  it  is  so  in  certain  resi^ects,  but  very  comivlex  when  you 
come  to  study  out  the  various  comjvlex  relations  of  the  nerves  and  the  effect 
we  may  get  iii^on  them  by  working  uiion  centers. 

II.  Landmarks  Holden  instances  the  following  x^oints:  The  oxmning 

between  the  eyelids  varies  in  size  in  different  x>ersons,  and  it  is  this  change 
and  not  a vaiiation  in  the  size  of  the  eyeball  which  makes  us  say  a x^^i’sou 
has  a large  or  small  eye,  as  the  eyeballs  are  very  nearly  of  the  same  size  in 
different  individuals.  The  external  angle  of  the  lid  is  generally  a little  higher 
than  the  internal  angle,  and  gives  an  arch  exx^ression  to  the  face.  The  closed 
lids  fit  accurately  together,  and  are  not  believed,  as  sometimes  stated,  to 
form  a channel  with  the  ball  of  the  eye  foi-  the  fiow  of  the  tears.  UxJon  shut- 
ting the  eye  the  ball  turns  slightly  ux)ward  and  inward,  and  in  that  way 
cleansing  the  cornea  of  any  foreign  substance  which  may  have  dropx^ed  ux^on 
it,  and  also  turning  the  x^nxiil  away  from  the  light.  The  puucta  laclirymalia 
are  familiar  to  you,  they  are  seen  at  'the  inner  angle  of  each  lid.  The 
lachrymal  sac  is  found  by  drawing  the  eyelids  outward,  tensing  in  that  way 
the  tendo  oculi,  which  crossess  the  lachrymal  sac  about  the  middle.  By 
placing  your  finger  ux)on  the  tendo  oculi  you  can  feel,  by  winking  the  eye. 
that  the  orbicularis  x^ulpebrarum  and  the  muscles  aboiit  the  eye,  keexi  that 
tendon  working  so  that  the  tears  are  x>umx)ed  into  the  lachrymal  sa(‘  and 
XJassed  into  the  nasal  duct.  The  nasal  tluctis  from  six  to  eight  l ues  long,  and 
XJasses  from  the  lachrymal  sac  downward-  It  oxvens  at  the  tox^  of  the  inferioi- 
meatus  or  sometimes  in  the  outer  wall.  The  left  nostril,  yon  will  see  uxmn 


118 


examination  is  .usually  narrower  than  the  right,  owing  to  a deviation  towai’d 
the  left  of  the  septum.  It  is  imiDortant  to  you  to  know  these  points,  so  that 
you  will  recognize  normal  conditions  and  not  confuse  them  with  disease. 
The  middle  and  inferior  spongy  bones  may  be  seen  by  dilating  the  nostril 
and  throwing  the  head  back.  They  are  red  in  color  and  must  be  carefull.\- 
distinguished  from  polypi. 

The  Osteopath  should  also  note  the  color  of  the  lips,  the  normal  Vermil- 
lion color  indicating  heath,  and  a departure  from  this  indicating  either  the 
state  of  the  circulation  or  condition  of  the  blood.  In  looking  into  the  mouth 
always  bear  in  mind  to  look  at  the  condition  of  the  tongue,  as  it  is  a great  in- 
dicator of  disease.  Upon  the  under  surface  of  the  tongue  is  a median  furrow 
upon  each  side  of  which  is  the  ranine  vein.  In  the  middle  line  of  the  floor  of 
the  mouth  is  the  frenum  linguje,  upon  each  side  of  which  is  the  opening  of 
the  duct  of  Wharton,  leading  from  the  submaxillary  glands,  which  you  may 
hnd  beneath  the  mucous  membrane  back  near  the  angle  of  the  jaw.  The 
sublingual  glands  are  in  the  ridge  of  mucous  membrane  each  side  of  the  mid- 
dle. The  shape  of  the  hard  palate  is  sometimes  signitigant,  usually  a broad 
arch,  sometimes  narrower  at  the  top  like  Gothic  arch,  and  it  is  said  that  in 
idiots  it  is  ciuite  sharp. 

In  examing  the  throat  it  is  a good  plan,  it  is  said,  to  hold  the  nose  so 
that  the  person  is  obliged  to  breath  through  the  mouth.  That  will  cause  a 
dilation  of  the  varous  parts  of  the  throat  and  a widening  of  the  fauces  and  a 
raising  of  the  soft  ijalate,  so  that  you  can  then  get  a good  view  of  the  internal 
parts  of  the  throat.  When  you  depress  the  tongue  it  should  be  done  gently 
with  your  finger  or  the  handle  of  a spoon  or  something  of  that  kind;  if  you 
are  rough  the  tongue  will  resist  the  effort  you  are  making  to  lower  it.  The 
operator  can  pass  his  finger  down  into  the  throat  past  the  epiglottis  as  far  as 
the  inferior  border  of  the  cricoid  cartilage;  as  far  as  the  beginning  of  the 
oesophagus,  and  can  make  out  the  greater  cornua  of  the  hyoid  bone  and  seek 
in  the  hyoid  spaces  on  each  side  where  any  foreign  bodj’  is  queit  apt  to 
lodge.  It  is  important  to  know  sometimes  that  behind  the  last  molar  tooth 
there  is  a small  aperature  through  which  a little  tube  may  be  introduced 
through  which  to  feed  a patient  in  spasmodic  closure  of  the  lower  jaw.  The 
place  where  the  surgeon  taps  the  antrum  is  just  above  the  second  bicusx^id 
tooth  about  an  inch  above  the  margin  of  the  gum.  The  aperature  of  the  pos- 
terior uares  may  be  felt  by  passing  the  finger  carefully  up  behind  the  soft 
palate,  and  there  can  be  made  out  by  the  touch  the  back  of  the  septum  and 
the  back  jjart  of  the  inferior  spongy  bone  in  each  nostril,  also  a grasijing 
feeling  from  the  action  of  the  suj)erior  constrictors  of  the  jjharynx. 

I have  already  spoken  concerning  the  tonsils.  They  lie  at  the  side  of  the 
thi'oat  just  behind  the  pillars,  and  in  examination  of  the  throat  if  you  see 
them  extending  beyond  those  jjillars,  .it  shows  they  are  abnormal  in  size. 
The  normal  tonsil  does  not  extend  beyond  the  level  of  the  pillars. 


114 


I have  mentioned  physiognomy  in  relation  to  examination  of  the  face.  It 
is  stated  that  the  insertion  of  the  muscles,  not  only  into  tendons  and  bony 
parts  of  the  face,  also  into  the  skin  all  over  the  face,  leads  to  the  formation  of 
lines.  That  the  passage  of  various  thoughts  through  the  mind  constantly  re- 
curring, calls  into  play  certain  sets  of  muscles,  and  finally  leaves  lines  uiion 
the  skin  at  the  places  of  contraction,  thus  creating  a reliable  method  by 
v'hieh  the  countenance  may  be  read,  and  which  is  sometimes  useful  to  us. 
There  are  two  of  these  lines  which  I wish  to  mention  particularly.  First, 
there  is  the  liute  nasalis,  extending  from  the  alte  nasi  out  to  the  angle  of  the 
mouth.  And  it  is  said  that  in  children  its  presence  denotes  some  abdominal 
trouble,  especially  inflammation  of  the  bowels;  in  older  persons  some  trouble 
with  the  stomach  or  abdominal  disease,  frequently  of  the  liver.  The  lin* 
labialis  extends  from  the  angle  of  the  mouth  down  to  the  side  of  the  jaw.  It 
is  seen  frequently  in  children  with  indammatory  diseases  of  the  larynx  or 
lungs,  and  in  older  people  who  have  laryngeal  and  bronchial  trouble,  and 
difficulty  of  breathing.  Of  course  the  Osteopath,  as  well  as  the  physician, 
should  become  familiar  with  the  indications  of  the  face,  know  its  natural  tem- 
perature and  different  things  about  it.  I cannot  mention  such  things  now, 
but  they  are  interesting  to  study  and  are  very  practical  in  directing  the  oper- 
ators attention  to  the  probabilities  of  disease — it  is  very  helpful  in  diagnosis. 

I wish  to-day  to  examine  further  the  parts  of  the  head,  and  show  you  the 
treatment  to  be  given. 

III.  Examination  of  the  Ear.  The  disease  may  be  in  the  external,  in 
the  internal,  or  in  the  middle  ear,  or  it  may  be  in  the  brain  or  in  the  auditory 
nerve  itself.  It  is  sometimes  very  difficult  to  say  where  the  location  of  the 
disease  is.  First:  As  to  examination  of  the  external  auditory  canal.  Since 

it  runs  forward  and  inward  and  is  slightly  curved,  you  must  draw  the  auricle 
upward  and  backward  to  be  able  to  look  down  into  the  external  canal.  You 
must  have  a good  light.  You  can  look  directly  in  without  the  aid  of  any 
instrument,  but  usually  the  operator  should  be  supplied  with  an  ear  speculum, 
which  is  a little  tube,  funnel  shaped,  polished  so  as  to  reflect  the  light. 
Frequently  a forehead  mirror  is  used;  a little  mirror  that  is  fastened  by  a 
band  about  the  forehead  with  an  aperature  in  the  middle,  through  whicli  the 
operator  may  look.  This  reflects  the  light,  and  reveals  the  interior  of  the 
canal.  In  looking  into  the  external  ear  you  may  notice  that  there  is  too  much 
or  too  little  wax,  indicating  some  general  disease.  You  may  notice  that 
there  are  growths  in  the  ear,  or  foreign  bodies,  such  as  buttons  in  childern’s 
ears,  or  insects,  or  the  wax  may  become  hard  and  impacted.  I had  a case 
once  in  which  a person  liad  noticed  a slight  deafness  continually  increasing 
until  Anally  he  was  not  able  to  hear  his  watch  tick  when  held  at  his  ear.  I 
found  by  examination  that  the  wax  had  become  impacted.  Of  course  he 
could  hear  iiiternally  by  certain  methods  employed  to  test  the  hearing.  I just 


115 


took  the  curved  end  of  a hair  pin  and  picked  out  the  wax,  and  he  could  hear 
all  I’ight.  It  is  quiet  a common  thing  in  persons  who  have  a poor  quality  of 
blood  to  have  furuncles,  or  boils,  in  the  external  auditory  canal.  Your  ex- 
amination of  the  ear  will  reveal  to  you  the  membrani  tympani,  which  should 
appear  concave.  It  is  in  color  a peaily  gray  and  glistens  with  the  reflection 
of  the  light.  You  can  see  the  processus  brevis  of  the  malleus  and  the  manu- 
brium of  the  malleus,  and  you  can  sometimes  with  a good  light  see  the  pro- 
cessus longus  of  the  incirs.  The  membrane  appears  concave;  the  most  con- 
cave part  at  the  end  of  the  manubrium,  is  called  the  umbo;  at  the  til?  of  the 
manubrium  appears  a bright  triangle  or  j)yramid  of  light  where  the  reflection 
is  brighter  than  at  other  parts.  Of  course  only  x^ractiee  will  make  you  fa- 
miliar with  the  normal  external  parts  and  appearance  of  the  membrane. 
Further,  you  should  always  in  examining  the  ear  look  for  perforations,  of 
the  membrane  because  those  frequently  occur  in  ear  troubles. 

As  to  the  middle  ear,  you  may  have  it  affected  by  different  diseases, 
among  which  are  inflammations,  catarrhs,  etc.,  in  which  case  pus  or  mucous 
may  collect  in  it.  In  that  case,  if  the  ear  were  filled  with  x^us  or  mucous, 
the  membrane  would  be  x>ushed  outward,  and  would  be  convex  instead  of 
concave.  By  examining  from  the  external  ear,  if  inflammation  were  x^resent 
there  would  be  a reddish  axopearance  of  the  membrane.  It  is  said  the  x^res- 
ence  of  mucous  or  pus  gives  a yellowish  tinge  to  the  membrane.  For  ex- 
amination to  see  whether  or  not  the  Eustachian  tube  be  closed  there  are  differ- 
ent methods  used.  One  is  for  the  patient  to  close  his  nose  and  mouth  and 
make  an  expiratory  effort,  eliciting  a crankling  sound  of  the  membrane,  due 
to  the  imxiaetof  the  air.  That  is  called  Yalsalra’s  method.  Another  method, 
called  Politzer’s,  is  practically  the  same.  The  x^atient  is  directed  to  swallow 
a little  water,  the  operator  having  introduced  a tube  through  one  nostril,  and 
closing  the  mouth  and  both  nostrils  except  the  tube,  through  this  tube  the 
operator  blows,  and  the  air  is  forced  np  towards  the  membrane,  and  in  case 
the  membrane  is  perforated  there  is  a whistling  sound  as  the  air  escapes.  Or 
if  there  is  an  accumulation  of  pus  or  fluids,  they  will  be  driven  into  the  ex- 
ternal ear.  In  case  of  closure  of  the  external  ear  it  is  said  that  there  is  an 
magnification  of  the  sound  in  the  middle  ear,  or  in  case  of  closure  of  the 
Eustachian  tube  the  same  thing  would  obtain,  or  in  case  there  was  too  much 
secretion  about  the  ossicles,  not  allowing  free  motion.  In  such  cases  it  is 
said  if  a tuning  fork  is  x^l^ced  on  the  mid-line  of  the  tox>  of  the  sknll.  or 
against  the  teeth,  the  sound  is  increased  in  the  affected  side.  If  it  is  heard 
louder  in  the  other  ear,  it  indicates  some  tronble  with  the  internal  ear  of  the 
affected  side.  Your  diagnosis  may  be  made  still  closer  by  xflacing  a watch  or 
tuning  fork  against  the  mastoid  x>rocess  of  the  affected  ear;  if  there  is  no  re- 
sx)onse  you  may  be  sure  the  trouble  is  in  the  internal  ear.  Those  are  a few 
methods  by  which  you  may  determine  where  is  the  trouble  that  is  affecting 


116 


the  ear.  Since  the  aurist  makes  the  ear  his  life  time  work,  we  cannot  do 
justice  t3  the  subject  in  any  one  or  two  lectures. 

lA".  Treatment  of  the  Ear — I have  already  shown  you  hoAv  to  ex- 
amine tlie  external  canal  of  the  ear;  the  usual  methods  are  employed  to  re- 
move foreign  substances,  or  in  case  of  impacted  wax  you  had  better  use  some 
warm  water;  it  may  take  several  sittings  to  remove  it  entirely,  and  the 
hearing  may  be  worse  after  the  first  treatment  with  the  water  because  of  the 
swelling  of  the  wax  filling  the  canal.  In  the  case  of  insects  in  the  ear  some 
warm  water  or  sweet  oil  may  be  introduced  with  a syringe.  In  ear  affections 
there  is  usnally  trouble  with  the  atlas  or  in  the  upper  cervical  region.  AA^e 
treat  then  the  lesion,  if  we  find  it,  in  the  neck,  and  we  treat  the  ear  largely 
by  regulating  the  blood  supply;  by  springing  the  jaw,  as  already  shown. 
The  chief  work  in  the  neck  is  on  the  superior  cervical  ganglion,  and  in  stimu- 
lating the  blood  flow  through  the  carotid  arteries.  Of  course  in  affections  of 
the  ear  from  catarrh  or  constitutional  troubles  you  would  have  to  direct  your 
treatment  to  the  general  condition  of  the  patient — look  after  his  general 
health.  I had  an  interesting  case  of  deafness  once  where  I did  not  treat  the 
ear  at  all.  I found  the  clavicle  was  slipped;  that  the  scaleni  muscles  were 
hard;  that  there  was  a paresis  of  the  right  arm.  I slipped  the  clavicle  back, 
treated  the  scaleni  muscles,  and  the  lady  went  up  stairs  and  immediately  called 
down  that  she  could  hear  the  clock  ticking  downstairs,  something  she  had 
not  done  before.  It  must  have  been  by  sympathetic  connection  of  the  nerves 
which  had  been  affected;  the  brachial  plexus  and  the  nerves  to  the  ear.  I 
do  not  know  of  any  other  way  to  account  for  it.  That  shows  yon  cannot 
always  work  according  to  rule,  but  you  must  look  for  the  cause  and  ti-eat 
wherever  that  may  occur. 

Examination  and  Treatment  of  the  ISTose: — Since  the  aperature  of 
the  nostril  is  on  a little  lower  level  than  the  bottom  of  the  passage  of  the 
nostril,  you  have  to  pull  the  nose  np  and  back.  You  can  dilate  it  with 
a speculum  used  for  the  purpose,  and  you  can  use  either  form  of  refle  cted 
light-  You  may  see  the  middle  and  inferior  turbinated  bones  and  the  marks 
I have  mentioned.  Y'ou  will  learn  to  recognize  the  normal  conditions,  and 
to  note  any  diseased  conditions  and  observe  whether  there  are  any  growths' 
in  the  nose;  the  polypus  is  the  most  common.  It  is  common  to  meet  with 
fractured  nasal  bones.  That  of  course  belongs  to  the  surgeon,  but  is  very 
readily  set.  You  can  diagnose  this  condition  by  holding  the  ear  close  and 
you  can  hear  a grating  sound  as  yon  move  the  nose.  I have  had  cases  in 
which  I would  simply  straighten  out  the  parts,  using  no  splint  or  anything 
of  that  kind.  I do  not  know  what  is  the  usual  method  surgically,  but  with 
no  splints  the  bones  willl  stay  in  j)osition  and  no  deformity  or  abnormality 
follow.  Yon  will  sometimes  notice  that  in  catarrh,  on  account  of  the  absoi’ii- 
tion  of  these  turbinated  bones,  the  nose  is  deflected  to  one  side  or  to  the  oth- 


117 


er.  The  usual  way  in  which  we  treat  the  nose,  aside  from  the  general  sys- 
tem which  is  adopted  in  catarrh,  the  freeing  of  the  blood  supply  in  the  neck 
and  of  the  blood  sui^ply  about  the  nose,  is  to  work  on  the  outside  of  the  nose 
and  loosen  all  the  tissues  along  the  side.  In  that  way  also  you  free  the  nasal 
duct  by  loosening  all  the  tissues.  Also  in  case  of  stoppage  of  the  nose  in 
colds  and  catarrh,  we  place  tlie  hand  flat  above  the  frontal  sinuses  and  press 
down  quite  hard.  You  can  sometimes  clear  the  nostrils  in  that  way  so  that 
the  stoiipage  is  gone  and  the  breathing  is  clear  through  the  nostrils.  There 
is  another  disease  which  you  frequently  meet,  a ringing  in  the  ear,  tinnitus 
rurium.  It  is  common  in  old  people,  and  it  is  common  also  in  constitutional 
diseases,  after  smistroke,  or  in  malnutrition,  and  old  age.  Therefore,  it  arises 
sometimes  from  conditions  of  general  health.  The  Osteopath  has  found  that  it 
is  due,  in  some  cases,  to  a stoppage  of  the  circulation  in  the  little  anastomosis 
on  the  ear  drum,  and  he  then  works  in  the  usual  method  to  free  up  the  carotid 
artery,  and  by  stretching  the  jaw.  Sometimes  the  trouble  is  in  an  obstruction 
to  the  auditory  nerve.  It  is  said  that  we  inhibit  the  auditory  nerve  by  pressure 
in  the  neck  opposite  the  third  cervieal,  by  steady  holding  there. 

I cannot  mention  in  such  a lecture  as  this  all  the  points  in  connection  with 
examination  of  the  mouth  and  throat.  That  also  is  a field  for  the  specialist.  I 
have  noted  that  you  should  see  the  condition  of  the  tongue,  whether  it  is 
furred,  what  its  temperature  is,  and  its  color.  These  are  very  indicative.  For 
instance,  it  is  said  that  a furred  tongue  is  indicative  of  a one-sided  disease,  as 
instance  of  the  liver  or  spleen.  A furred  tongue  has  been  noticed  by  Hilton  in 
a ease  of  ulceration  of  the  teeth.  The  half  of  the  tongue  on  the  side  of  the 
mouth  affected  by  the  tooth  was  furred,  and  there  was  stiffness  of  the  jaw.  Of 
course  he  referred  it  to  the  fifth  nerve,  which  supplies  the  muscles  of  the  jaw 
and  supplies  also  a part  of  the  tongue.  As  to  the  color  of  the  tongue,  we 
might  mention  for  instance,  the  strawberry  tongue,  as  it  is  called,  in  scarlet 
fever,  or  the  lead  colored  thrush-covered  tongue  in  the  dying. 

You  will  observe  the  tonsils,  the  uvula  and  the  condition  of  the  fauces. 
Frequently  in  diseases  of  the  throat  the  uvula  is  inflamed  or  edemetous  and  is 
hanging  down,  obstructing  the  passage  of  the  air,  and  keeping  the  patient  con- 
tinually coughing.  There  are  certain  times  when  we  give  internal  treatment 
to  the  mouth  and  throat,  but  not  very  frequently.  That  is.  in  case  of  catarrh, 
tonsilitis,  or  something  of  that  kind.  We  sometimes  insert  the  fingers  and  by 
a prerssure  upward  and  outward  along  the  pillars  of  the  fauces,  we  free  the 
circulation  to  those  parts,  and  can  in  that  way  to  a considerable  extent  allay 
the  inflammation.  That  is,  we  frequently  relax  congested  and  contracted 
parts.  The  general  treatment  for  the  throat  I have  shown  you,  by  loosening 
the  muscles  and  by  working  to  free  the  blood  supply,  but  you  must  also  be 
sure  that  all  the  muscles  throughout  the  neck  are  relaxed.  YYu  can  feel  those 
in  the  back  of  the  neck,  as  I have  already  shown.  You  cannot,  however,  feel 


118 


the  anterior  spinal  muscles  in  the  neck,  you  must  take  into  consideration  the 
probability  that  where  others  are  contracted,  they  also  are,  and  adapt  your  dif- 
ferent motions  to  the  stretching  of  those  muscles;  simply  by  stretching  the 
head  backward  you  can  free  all  the  branches  of  the  nerves. 

There  is  a great  deal  more  that  might  be  said  both  in  general  and  in  parti- 
cular concerning  the  eye,  ear,  nose,  throat,  and  parts  of  the  head,  but  I think 
that  in  the  three  lectures  that  I have  given  you  I have  been  able  to  give  you  the 
usual  Osteopathic  treatment  for  the  parts  of  the  head,  and  to  give  a general 
idea  of  the  importance  of  these  things.  Of  course  we  depend  entirely  upon  the 
nerve  and  blood  supply.  That  after  all  is  the  best  part  of  the  work. 

Q.  In  regard  to  examination  of  the  nostril,  you  said  we  should  observe 
the  turbinated  bones.  Is  there  any  way  by  which  you  can  remove  abnormal 
growths  from  that  bone  osteopathically  ? 

A.  That  bone  is  very  frequently  softened  by  catarrh,  sometimes  ulcerated 
and  eaten  away,  and  in  so  far  as  you  can  influence  catarrh,  with  which  we  have 
good  results,  you  could  influence  this  other  trouble,  and  by  work  upon  the  nose 
you  might  gradually  work  the  parts  back  into  their  normal  condition. 

Q.  You  spoke  of  dropping  of  the  uvula,  is  that  not  caused  largely  by 
catarrh  ? 

A.  Yes,  sir,  in  general.  Anything  which  would  inflame,  of  which  catarrh 
is  a sample. 


LECTUEE  XIX. 

At  the  eighteenth  lecture  I considered  certain  Osteopathic  points  about  the 
head,  giving  you  certain  centers  for  the  head  and  its  parts,  which  I need  not  re- 
peat here  ; something  concerning  the  vaso  motors,  that  the  Osteopath  had  there- 
fore a good  field  upon  which  to  work  in  treating  the  head  and  all  its  parts,  the 
brain  included.  I then  instanced  certain  landmarks,  and  took  up  further  the 
subject  of  how  to  examine  the  parts  of  the  head,  including  the  eye,  nose,  throat 
and  mouth.  I wish  to-day  to  call  your  attention  further  to  the  thorax  and  its 
parts.  We  have  so  far  in  our  Osteopathic  work  seen  how  to  examine  the  spine, 
neck,  head,  etc.,  the  significance  of  points  discovered;  also  how  to  treat  them. 
It  is  of  great  interest  to  us  now  to  go  to  the  thorax.  And  in  going  to  the  thorax 
it  is  quite  fitting  that  I should  say  something  in  particular  about  the  splanchnic 
nerves.  I have  said  something  concerning  these  nerves  already,  but  think 
something  more  in  particular  would  be  of  value  to  you.  The  splauchnics,  as 
you  probably  already  know,  are  some  of  the  most  important  tools  with  which 
the  Osteopath  works,  and  I will  venture  the  assertion  that  there  will  be  hardl_y 
a day  in  your  practice  pass  without  your  working  upon  the  splanehnics.  They 
are  of  such  far  reaching  connection  that  their  importance  at  once  becomes  ap- 
parent, hence,  their  constant  use  by  the  Osteopath.  As  to  definition,  you  know 


119 


what  splanchnology  is — the  science  of  the  viscera.  Hence,  the  splanchnics, 
refers  to  visceral  nerves,  those  nerves  governing  the  viscera,  and  it  is  in  this 
fact  that  their  significance  lies.  It  is  with  the  sympathetic  splanchnic  nerves 
that  we  as  Osteopaths  have  to  deal,  and  it  is  because  of  their  far  reaching  con- 
trol of  visceral  life  and  the  wonderful  results  the  Osteopath  can  get  in  working 
upon  them,  that  he  has  been  so  successful  in  treatment  of  diseases  in  general. 
That  is  one  of  the  reasons,  I should  say. 

Now,  as  to  what  these  nerves  are,  we  know  at  once  that  they  are  the 
sympathetics  from  the  lateral  chains  of  thoracic  ganglia.  I want  to  bring  out 
a few  points  concerning  these  nerves  by  way  of  review,  so  that  we  will  know 
what  we  are  working  with.  First,  the  great  splanchnic  arises  from  as  high  as 
the  fifth  or  sixth,  and  from  all  of  the  thoracic  ganglia  below  down  to  the  ninth 
or  tenth.  It  perforates  the  diaphragm  and  joins  the  lower  part  of  the  semi- 
lunar ganglion.  In  the  chest  it  sometimes  divides  and  forms  a plexus  with  the 
smaller  splanchnic.  As  to  the  nature  of  these  fibers,  they  are  white,  medul- 
lated  fibers.  You  remember  in  one  of  the  first  lectures  I called  your  attention 
to  the  fact  that  in  the  sympathetic  there  are  two  kinds  of  fibers.  And  it  is 
stated  by  Quain  that  about  four-fifths  of  the  fibers  of  the  splanchnics  are  made 
up  of  white  medullated  fibers,  and  they  come  direct  from  the  anterior  roots  of 
the  spinal  nerves.  This  greater  splanchnic  maj-  arise  as  high  as  the  third 
thoracic.  Gray,  I believe,  states  it  may  receive  branches  from  the  upper  six 
thoracic.  This  greater  splanchnic  gives  branches  in  front  to  the  aorta  itself 
and  to  the  front  of  the  vertebrae. 

As  to  the  smaller  splanchnic,  it  arises  from  the  ninth  and  tenth,  as  usually 
described,  sometimes  from  the  tenth  and  eleventh,  thoracic  ganglia.  Or.  it 
may  not  arise  from  the  ganglia,  it  may  arise  from  the  sympathetic  cord  itself 
without  the  intervention  of  ganglia.  It  also  passes  through  the  diaphragm, 
sometimes  separately,  and  sometimes  in  conjunction  with  the  cord  of  the 
greater  splanchnic.  It  also  joins  the  lower  part  of  the  semi-lunar  ganglion, 
and  sends  branches  to  the  renal  plexus  in  ease  the  renal  splanchnic  is  wanting, 
or  in  case  it  is  small. 

The  smallest  or  renal  splanchnic,  as  you  gather  from  the  above,  is  some- 
times wanting.  It  arises  from  the  last  thoracic  ganglion,  and  passes 
through  the  diaphragm  in  connection  with  the  general  sympathetic  cord,  and 
goes  to  the  renal  plexus,  not  the  semi-lunar  ganglion. 

A fourth  splanchnic  is  sometimes  described.  It  is  stated  that  Wrisberg 
in  eight  instances  out  of  a great  many  found  a fourth  splanchnic  is  the  cervical 
region. 

We  all  understand  what  is  meant  in  general  when  we  speak  of 
the  splanchnics.  That  is,  these,  three  splanchnic  nerves.  But  you  will 
see  that  it  is  sometimes  used  in  a different  sense.  Gaskell,  quoted  by  Quain. 
says  that  there  are  visceral  branches  from  the  second,  third  and  fourth  sacral 


120 


nerves,  and  these  he  calls  the  “sacral  or  pelvic  splanchnics.”  “The  cervieo- 
eranial  rami  viscerales”  are  visceral  branches  from  the  spinal  accessory,  puen- 
mogastric  and  glosso-pharyngeal  and  facial  nerves.  So  you  see  that  visceral 
nerves  have  their  origin  from  these  cranial  nerves ; also  a branch  from  the 
ciliary  ganglion  from  the  third  nerve.  Byron  Robinson  has  this  to  say  con- 
cerning splanchnics  in  general.  “There  are  certain  fine  white  medullated 
nerves,  which  Gaskell  mentioned,  and  which  pass  from  the  spinal  cord  in  the 
white  rami  communieantes  between  the  second  dorsal  and  second  lumbar  nerves 
inclusively,  to  supply  viscera  and  blood  vessels.  These  nerves  should  be  called, 
as  Gaskell  suggests,  splanchnics.  Hence,  we  will  have,  first,  the  thoracic 
splanchnics  ; second,  the  abdominal  splanchnics,  and  third,  the  pelvic  splanch- 
nics. Hence,  you  will  see  the  general  use  to  which  Gaskell  put  the  term,  in 
the  use  of  which  the  other  authorities  have  concurred.  Robinson  says  further, 
that  these  white  rami  communieantes  extend  from  the  second  dorsal  to  the  sec- 
ond lumbar,  but  we  know  that  along  this  region  and  in  the  region  above  the 
second  dorsal  and  below  the  second  lumbar,  gray  ones  are  found. 
In  the  last  two  named  regions  gray  exclusively.  That  variety  he  calls 
peripheral,  supplying  the  parietes  of  the  body.  From  the  foregoing,  and  what 
has  been  said  in  general  concerning  splanchnics,  we  see  that  the  splanchnics 
proper  of  which  we  speak,  are  white  medullated  fibers,  for  the  most  part,  and 
that  their  particular  function  is  to  attend  to  the  blood  vessels  and  to  the  viscera. 
Flint  says  that  the  splanchnics  are  the  most  important  vaso-motors  of  the 
system.  And  further,  Quain  states  that  the  medullated  fibers,  that  is,  such  as 
we  find  in  the  '.planchnies,  which  pass  in  the  sympathetic  system,  are  classed 
by  Kolliker  as  (a)  sensory,  (b)  vaso  and  viscero  constrictors,  and  (c)  vaso  and 
viscero-dilators.  Hence,  we  have  passing  from  the  spinal  cord  along  into  the 
great  prevertebral  plexuses  in  the  different  regions  these  sensory,  vaso-dilators 
and  contrictors  and  viscero  inhibitors  and  constrictors.  He  goes  on  further  to 
say  that  the  sensory  are  found  onlj’  passing  from  the  cranial  nerves,  but  that 
these  visceral  and  vaso-motor  fibers  are  found  all  the  way  down  the  cord. 
Hence  we  see  at  once  that  these  visceral  and  vaso-motor  branches  are  found  in 
the  splanchnics.  In  line  with  the  above  Quain  says  further,  that  the  splanchnic 
nerves  proper,  act  first,  as  viscero-inhibitoiy  fibers  for  the  stomach  and  intes- 
tines ; second,  as  vaso-motor  fibers  to  the  abdominal  blood  vessels ; third,  as 
afferent  fdiers  from  the  abdominal  viscera.  That  is,  fibers  from  the  abdominal 
viscera  back  to  the  center.  And  that  explains  why  it  is  that  we  get  secondary 
lesions,  as  we  call  them.  You  may  have  some  trouble  in  a viscus  somewhere, 
and  knowing  that  you  have  afferent  fibers  from  the  viscus  back  to  the  center, 
you  can  account  for  the  center  being  affected,  and  the  imjmlse  coming  out 
from  it  to  the  posterior  spinal  nerves,  for  examine,  and  causing  constracture 
of  the  muscles  in  the  back.  I have  already  said  enough  to  show  you  the  im- 
portance of  the  splanchnics — to  show  you  in  general  their  nature  and  fuuc- 


121 


tiou.  They  become  still  more  significant  to  the  Osteopath  when  he  considers 
their  connections  with  the  other  parts  of  the  sympathetic  system.  In  the  first 
place,  they  must  be  connected  with  the  spinal  cord  itself,  since  they  arise 
from  the  anterior  roots,  and,  through  the  cord,  with  the  brain.  It  is  doubt- 
ful how  close  a connection  they  have  with  the  brain  centers,  but  they  have  at 
least  a close  conneetion  with  the  bulbar  center,  the  vaso  constrictor  center 
of  the  medulla.  Then  it  is  probable  that  these  splanchnics  have  a close  con- 
nection also  with  cardiac  and  pulmonary  fibers  arising  from  the  upper  part 
of  the  spinal  cord;  because  we  have  seen  that  the  center  for  the  lungs  extends 
from  the  second  to  the  seventh  dorsal,  and  that  we  work  in  the  upper  dorsal 
region  for  the  heart,  and  there  are  certain  vaso  motor  fibers  from  these  re- 
gions to  the  heart  and  lungs,  so  that  it  is  almost  undisputable  that  there  is  a 
connection  between  the  splanchnics  and  what  we  might  call  other  splanchnics 
for  the  heart  and  lungs.  In  the  next  i^lace,  we  have  seen  that  the  first  two 
join  the  semi-lunar  ganglion  and  the  third  the  renal  ganglion.  And  they  are 
connected  directly  with  the  solar  plexus,  and  through  it  with  the  other  great 
prevertebral  plexus,  the  hypogastric  plexus,  and  through  that  with  those  lit- 
tle secondary  j)lexuses,  such  as  the  superior  and  inferior  mesenteric,  hem- 
orrhoidal, ijortal,  Auerbach’s  and  Meissner’s,  and  the  various  plexuses 
throughout  the  pelvis  and  elsewhere.  Hence,  anyone  who  sees  the  sigui- 
ficance  of  osteopathic  work  will  see  the  significance  of  this  far  reaching  con- 
nection with  visceral  and  organic  life.  Then,  again,  remember,  that  in  the 
thorax  the  first  or  greater  splanchnic  sends  branches  directly  to  the  aorta  it- 
self. Hence  it  is  that  the  operator  so  frequently  works  upon  the  splanchnics; 
it  does  not  make  any  difference  what  kind  of  trouble  you  may  have,  your  gen- 
eral health  is  likely  to  be  affected,  and  it  must  be  attended  to;  and  whether 
you  are  working  upon  the  stomach,  liver,  portal  system,  upon  the  intestines, 
or  pelvic  viscera,  you  will  work  at  least  in  j)art  upon  the  splanchnics. 

There  is  a second  sense  in  which  we  mast  consider  the  use  of  these 
splanchnic  nerves,  and  we  may  state  the  matter  this  way:  That  work  upon 

the  splanchnic  nerve  is  frequentlj^  a regulative  process.  I might  illustrate  what 
I mean  by  that.  Here  you  have  a set  of  sympathetic  nerves,  they  are  vaso- 
motor nerves  for  very  important  parts  of  the  body,  viz : the  internal  viscera, 
which  receives  an  exceedingly  large  blood  supply.  If  the  osteopathic  ability 
to  work  upon  the  nerve  centers  and  nerve  connections  stands  for  anything,  it 
must  certainly  stand  for  something  when  it  goes  to  work  upon  these  splaneh- 
nics.  Hence,  he  must  have  a large  control  throughout  a great  portion  of  the 
circulation  of  the  body  since  it  is  so  richly  supplied  from  these  nerves.  Here 
you  have  a quantity  of  blood  in  the  bodj- ; we  will  saj’  in  a certain  case  it  is  un- 
equally divided.  The  Osteopath’s  work  is  sometimes  to  equalize  the  circulation 
throughout  the  body.  In  case  you  have  a headache,  which  is  frequently  a con- 
gestion in  the  cranium,  what  do  you  wish  to  do?  You  wish  to  regulate  the 


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circulation.  You  must  therefore  employ  some  regulative  process,  and  very 
frequently  we  work  upon  these  splanchnies  to  throw  this  congestion  somewhere 
else  where  it  will  do  no  harm.  Another  thing,  the  most  natural  place  for  the 
overplus  of  blood  to  go  is  in  the  abdominal  veins.  Green  makes  the  statement 
that  the  abdominal  veins  are  the  most  easily  dilated,  and  while  I cannot  exactly 
quote  from  him,  I believe  he  goes  on  to  say  that  the  over-plus  of  blood  is  most 
readily  thrown  there.  At  any  rate  I can  state  it  is  my  experience  that  we  can 
get  important  results  by  throwing  the  congested  blood  to  the  abdominal  veins, 
and  we  do  cause  another  congestion  there.  Not  long  ago  I had  a case  of  head 
ache ; it  came  from  prolapsus.  The  lady  had  vomited,  and  had  had  trouble 
with  her  stomach  and  trouble  generally.  I gave  the  usual  treatments,  as  I al- 
ways do  first,  working  about  the  region  of  the  stomach  and  liver  and  over  the 
splanchnies,  as  it  looked  as  if  the  case  at  first  might  be  a ease  of  sick  head  ache, 
later  she  told  me  it  was  from  prolapsus.  I then  treated  all  about  her  head,  but 
the  head  ache  did  not  go  until  I finally  pressed  deeply  over  the  region  of  the 
solar  plexus.  By  deep  pressure  there  until  you  can  feel  the  pulsation  of  the 
abdominal  aorta,  you  will  get  important  results  very  frequently.  In  other 
cases  I have  relieved  head  ache  by  simply  pressing  there.  Now,  wheather  that 
was  simjtly  inhibition  over  the  solar  plexus,  and  thus  to  the  brain,  and  thus 
quieting  the  painful  sense,  I could  not  say,  but  it  looks  to  me  more  likely  that 
it  was  a regulative  process  which  inhibited  the  solar  splanchnic  and  allowed 
the  blood  to  come  to  the  veins  of  the  abdomen,  and  thus  relieved  the  congestion 
in  other  parts.  There  is  another  thing  tnat  I frequently  notice  in  my  practice, 
that  IS  I get  effects  upon  the  circulation  of  the  body  by  a general  spinal  treat- 
ment, which  of  course  involves  work  upon  the  splanchnic  region.  And  I can, 
by  working  there,  coupled  with  the  usual  treatment  I give  the  heart,  get  better 
results  in  quieting  the  pulse  than  I can  by  other  methods.  It  seems  to  me  it  is 
because  I get  a dilation  of  the  vessels  in  general  thoughout  the  abdominal 
viscera,  hence  lessening  of  the  tension  and  slowing  of  the  blood  How  follows, 
and  a quieting  of  the  pulse.  A case  of  the  same  kind  might  be  mentioned 
where  a congested  uterus  was  relieved  by  work  over  the  splanchnic  region. 
How  we  reach  and  treat  that  region  I will  show  you  in  detail  in  the  third  part 
of  the  lecture. 

In  line  with  what  I have  stated,  Howell’s  Text  Book  says  that  visceral 
changes  produced  refiexly  in  the  splanchnic  area  are  of  especial  importance  be- 
cause of  the  great  number  of  vessels  innervated 'through  these  nerves,  and  the 
great  changes  in  blood  pressure  that  can  follow  dilation  or  constriction  cn  so 
large  a scale.  Some  one  asked  me  some  time  ago  how  we  worked  to  cure  a 
cold.  I told  him  that  was  a matter  of  general  treatment  which  I shall  take  up 
later.  However,  we  give  a spinal  treatment,  drawing  the  congestion  from  the 
part  affected,  which  is  very  frequently  the  head,  and  give  relief.  That  is,  we 
work  upon  a large  amount  of  blood  controlled  by  the  splanchnies,  and  thus 


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draw  it  away  from  the  congested  part.  We  thus  see  that  it  is  a very  probable, 
and,  in  view  of  the  facts  it  is  quite  likely  the  case,  that  the  Osteopath  can  al- 
most at  will  throw  large  quantities  of  blood  to  the  abdominal  region,  or  away 
from  it,  by  proper  treatment.  I might  state  in  passing  that  it  is  a principle 
that  we  might  take  notice  of  that  in  a case  of  congestion  it  is  a good  plan  to 
divert  the  congestion  to  some  other  part  where  it  will  do  no  harm.  We  stated 
the  other  day  when  the  matter  was  brought  up  that  the  way  to  treat  it  was  to 
sweep  it  out  by  freeing  the  arterial  blood  flow  to  the  part.  I am  indebted  to 
Dr.  Conner  for  the  suggestion  that  it  is  well  to  divert  the  congestion  to  a part 
where  it  will  do  no  harm.  I saw  him  treat  a case  some  time  ago,  an  old  lady 
with  a very  troublesome  cold  in  her  head,  which  gave  her  headache  and  caused 
her  a great  deal  of  trouble.  She  had  been  treated  for  some  broncial  trouble 
and  the  pain  had  left  the  upper  part  of  the  chest  and  she  thought  the  conges- 
tion had  been  forced  into  the  head.  Several  had  treated  the  ease  unsuciess- 
fully.  Dr. Connor  just  came  in  and  raised  the  clavicle  and  twisted  the  see  a time 
or  two  and  went  out.  I saw  him  later  in  the  hall  and  asked  him  about  it.  He 
said  “ I just  lifted  that  clavicle  and  sent  the  congestion  down  the  arm 
where  it  would  do  no  harm.”  I think  we  very  frequently  use  the  method  and 
throw  the  blood  somewhere  else,  but  when  it  is  thrown  somewhere  else  I do  not 
believe  it  is  congestion.  Howell’s  Text-book  says  further:  "‘Anemia  or 

asphyxia  of  the  brain  stimulates  the  cells  composing  the  center,  that  is  the 
vaso-motor  center,  and  more  blood  enters  the  cranial  cavity  where  it  is  needed. 
Doubless  the  splanchnic  area  plays  an  important  part  in  this  restoration  pro- 
cess.” Hence  we  see  from  that,  in  the  first  place  that  the  Osteopath  may  by 
his  appropriate  methods  influence  the  blood  in  the  splanchnic  area  bj'  work 
upon  the  vaso-motor  area  in  the  medulla.  And  since  it  is  a poor  rule  that  will 
not  work  either  way,  he  can  do  the  reverse.  That  is,  he  can  affect  blood  flow  in 
the  head  by  work  upon  the  splanchnic  direct.  Our  conclusions  may  be  ex- 
pressed under  two  heads : First,  that  in  work  upon  the  splauchnies  the  Os- 

teopath works  upon  them  for  the  effect  that  it  gets  upon  the  connected  vdscera 
supplied  by  those  splanchmes.  That  he  works  upon  them  in  a secondary  man- 
ner frequently  for  regulation  of  blood  currents  to  the  body  generally  or  in 
some  particular  part  of  the  body. 

II.  Landmarks. — According  to  Holden:  Since  the  heart  and  lungs  are 

contained  in  the  thorax,  and  since  adnormalities  of  parts  of  the  thorax  may 
cause  serious  troubles  with  these  important  viscera,  and  since  the  Osteoiiath 
finds  so  many  things  upon  which  to  work  about  the  thorax,  I hardly  need  to 
say  to  you  that  it  is  imiiortant  that  we  know  the  landmarks  of  the  thorax 
thoroughly.  I have  given  you  some  in  connection  with  the  spine,  but  you 
will  notice  the  following:  As  a rule  the  right  side  of  the  chest  is  a little 

larger  than  the  left  and  you  should  bear  that  in  mind  in  making  your  ex- 
amination. In  the  female  the  sternum  is  shorter,  aud  the  upper  ribs  are  more 


123 


movable,  and  the  upper  aperature  of  the  sternum  is  on  a level  with  the  sec- 
ond dorsal  vertebra,  is  ciuite  narrow,  rarely  exceeding  two  inches.  Behind  the 
first  bone  of  the  sternum  there  is  no  lung  tissue.  The  left  vena  innominata 
crosses  behind  the  sternum  about  an  inch  below  the  top.  Xext  come  the 
great  primary  branches  from  the  aorta.  You  get  deeper  in  this  region  the 
trachea  bifurcation  at  about  the  level  of  the  junction  of  the  first  and  second 
parts  of  the  sternum;  and  deepest  of  all  lies  the  oesophagus.  On  the  bifurca- 
tion of  the  trachea  and  about  an  inch  below  the  upj)er  margin  of  the  sternum 
lies  the  highest  part  of  the  arch  of  the  aorta,  which  curves  on  over  the  left 
bronchus.  The  course  of  the  innominate  artery  corresponds  to  a fine  drawn 
rom  the  middle  of  the  junction  of  the  first  and  second  bones  of  the  sternum 
to  the  right  sterno- clavicular  articulatioh.  All  these  are  interesting  to  know. 
Here  is  something  that  is  absolutely  essential  to  know: 

Eules  for  counting  the  ribs:  In  passing  your  fingers  down  the  sternum 

in  front  you  can  readily  detect  where  the  first  part  ends  and  the  second  part 
begins.  Here  is  the  junction  of  the  cartilege  of  the  second  rib  with  the 
sternum.  The  first  rib  is  found  by  feeling  behind  the  clavicle  above.  You 
can,  by  deep  pressure,  come  to  the  first  rib.  The  first  and  second  ribs  give  a 
great  deal  of  trouble,  and  it  is  important  to  keep  in  mind  this  rule  to  find 
them.  In  the  male  the  nipple  is  usually  between  the  third  and  fourth  ribs 
three-quarters  of  an  inch  external  to  the  line  of  their  cartileges.  It  is  said 
that  the  lower  external  border  of  the  pectoralis  major  corresponds  in  direction 
with  the  fifth  rib,  that  a horizontal  line  drawn  from  the  nipple  right  around 
the  body  will  cut  the  sixth  intercostal  space  at  a point  midway  between  the 
sternum  and  the  spine.  \Yhen  the  arm  is  raised  the  highest  visible  digitation 
of  the  serratus  magnus  corresponds  with  the  sixth  rib,  and  the  seventh  and 
eighth  digitations  correspond  with  the  seventh  and  eighth  ribs  below.  I have 
already  noted  that  the  scapula  lies  on  the  ribs  from  the  second  to  the  seventh 
inclusive.  The  eleventh  and  twelfth  ribs  are  readily  recognized,  even  in 
fleshy  persons,  at  the  outer  edge  of  the  erectors  spinre,  sloping  downward. 
The  sternal  end  of  each  rib,  of  course,  as  you  know,  is  lower  than  the  end 
which  joins  the  spine,  and  it  is  said  that  if  a horizontal  line  was  drawn  from 
the  middle  of  the  third  costal  cartilage  at  its  junction  with  the  sternum,  it 
would  touch  the  body  of  the  sixth  dorsal  vertebra.  The  end  of  the  sternum 
is  upon  a level  with  the  tenth  dorsal  vertebra,  its  length  varying  some  in  dif- 
ferent individuals,  more  in  females  than  in  males. 

HI.  (a)  How  to  treat  the  splanchnics.  (b)  How  to  examine  the  thorax. 
There  are  various  ways  in  which  we  may  treat  the  splanchnics.  One  of  the 
best  ways  to  treat  the  splanchnics,  especially  the  renal  splanchnics,  is  to  have 
the  patient  on  the  back,  everything  being  relaxed.  If  you  are  afraid  that  the 
psoas  muscles  will  not  be  relaxed,  you  can  raise  the  limbs,  and  then  every 
thing  certainly  will  be.  And  then,  by  reaching  under  and  raising  the  patient 


124 


on  the  tips  of  the  fingers,  we  can  get  one  of  the  most  important  effects  uxjon 
the  splanchnics,  especially  the  renal  splanchnics.  Dr.  Harry  treats  in  that 
way  almost  entirely  for  the  kidneys.  We  may  also  treat  the  splanchnics  by 
having  the  patient  on  the  side  and  springing  up  the  spine  all  the  way  along 
the  region  of  the  splanchnics.  Also,  one  way  you  can  work  is  by  loosening 
up  all  these  muscles,  or  you  might  have  the  patient  upon  the  face  and  work 
as  I have  already  shown  you,  and  this  restricted  particularly  to  the  splanch- 
nic region  will  stimulate  the  splanchnics.  There  is  one  more  important  way 
in  which  we  reach  the  splanchnics,  and  it  is  something  we  aj^ply  usually  to 
the  treatment  of  the  liver,  which  of  course  must  be  done  directly  over  the 
splanchnics.  In  treating  the  liver  I always  end  up  in  this  way,  reaching 
over  with  the  left  hand  I get  it  against  the  angles  of  the  rib^  bent  in  this  way 
to  make  a fulcrum  of  the  hand.  Then,  having  hold  of  the  arm  of  the  jjatient 
just  below  the  elbow,  I push  it  up  and  back  near  the  head  and  then  back- 
ward; that  raises  the  ribs,  and  of  course  it  gets  an  effect  also  upon  the 
splanchnics,  that  is,  directly;  it  will  also  act  mechanically  in  freeing  the  ribs 
here  and  giving  the  liver  more  space  in  which  to  work.  Once  more  as  to  how 
we  can  reach  the  splanchnics  in  front.  This  is  the  motion  I use  just  here  at 
the  front;  deep  pressure  until  you  can  feel  the  pulsation  of  the  abdominal 
aorta.  It  is  apt  to  hurt  some  patients  quite  a little,  you  will  have  to  be  very 
careful,  some  it  will  not  hurt  much,  and  if  you  do  it  gently  and  have  quite 
a prolonged  joressure  there,  you  can  often  get  the  most  astonishing  results.  It 
is  said  also  that  this  jiressure  treatment  here  is  very  good  to  condense  gas  in 
bloating  of  the  abdomen. 

As  to  the  examination  of  the  thorax,  it  is  quite  a long  question,  and  I 
will  have  to  let  some  of  it  go  over  until  the  next  lecture,  but  I might  call  your 
attention  to  the  importance  of  making  very  careful  examination  of  the  thorax. 

In  examining  the  thorax  you  should  have  the  patient  lying  lying  flat 
uj^on  his  back.  First,  remember  that  the  right  side  is  usually  a little  larger 
than  the  left.  You  should  by  inspection,  next  the  skin  if  possible,  see  that 
both  sides  are  about  the  same  size — that  one  does  not  bulge  more  than  the 
other.  You  will  find  important  changes  in  the  shape  of  the  thorax.  For  in- 
stance, I saw  a case  of  enlargement  of  the  heart  from  cigarette  smoking,  there 
was  a perceptible  bulge  in  the  precardial  region.  In  anoi’her  case,  of  asthma. 
I saw  quite  a bulge  upon  the  right  ride  along  the  region  of  the  upper  ribs. 
Also  see  that  when  the  patient  is  standing  the  thorax  is  in  shai)e:  that  is.  that 
one  side  is  not  dropped  more  than  the  other.  Some  times  we  will  find  one 
side  of  the  thorax  dropped.  It  is  i)roi)er  in  making  your  examination,  espe- 
cially by  pali)ation,  to  put  both  hands  upon  the  part,  so  that  you  involun- 
tarily eomi^are  the  parts.  If  I were  examining  this  thorax  uj^on  the  left  side 
particularly,  I would  put  my  left  hand  upon  the  side  opposite,  so  that  I could 
comijare  the  parts  as  I work  over  it. 


126 


Of  course  to  examine  in  front  and  behind.  Then  you  put  your  hand  over 
the  surface  of  the  skin  to  detect  any  departure  from  the  normal  temperature. 
I have  already  noted  the  importance  of  that  in  examination  of  the  liver;  in 
conditions  resulting  from  diseased  liver  it  is  said  that  very  frequently  cold 
spots  are  found  upon  the  suxtace  of  the  body.  However,  yoxi  will  have  to  be 
a little  careful  on  a warm  summer  day,  a person  being  in  a state  of  perspira- 
tion the  skin  will  cool  very  rapidly.  Then  you  should  observe  the  shape  of 
the  thorax — whether  the  general  shape  be  normal.  In  an  infant  yoxi  will  find 
it  cylindrical.  In  asthma  and  emphysema  you  will  find  the  characteristic 
bari-el-shaped  chest.  In  what  is  known  as  the  paralytic  chest  the  antero-pos- 
terior  diameter  is  lessened  and  the  chest  is  flattened.  I have  already  men- 
tioned that  to  you  in  cases  of  neurasthenia.  The  rachitic  chest  is  flattened 
upon  the  sides.  Also  look  closely  at  the  sternum.  It  may  be  abnormally 
protruded  or  retracted,  or  there  may  be  malposition  at  the  junction  of  the  first 
and  second  parts,  and  the  ensiform  appendix  may  be  deflected  to  one  side. 

Finally,  look  at  the  clavicle  and  the  coracoid  pi’ocess.  You  know  where 
to  find  the  coracoid,  on  the  front  part  of  the  shoulder  at  the  origin  of  the 
coraco-brachialis  muscle.  It  is  easily  found.  Sometimes  the  fibers  of  the 
xleltoid  get  caught  below  it,  sometimes  the  fibers  of  the  brachial  plexus.  The 
clavicle  may  be  up  or  down  at  either  exti’emity.  You  will  acquaint  yourself 
with  the  normal  feeling  here  at  the  junction  of  the  clavicle  with  the  scapula 
ami  will  readily  detect  when  it  has  slipped  up  or  down.  You  can  also  see  if 
it  has  slipped  down  by  seeing  whether  it  is  close  to  the  coracoid  process  at 
the  scapular  end,  you  will  recognize  whether  it  corresponds  with  the  normal. 
At  the  upper  part  of  the  sternum,  the  clavicle  sets  up  quite  pi’omineutly.  It 
may  slip  down  or  be  too  high  up,  and  you  must  learn  to  look  for  all  these 
things  carefully. 


LECTURE  XX. 

At  the  last  lecture  I considered  especially  the  splanchnic  nerves,  show- 
ing you  their  origin,  that  they  arise  from  as  high  as  the  thirxl  dorsal  down  to 
the  twelfth;  that  they  were  composed,  largely  at  least,  of  white  medullated 
fibers;  that  they  were  closely  connected  with  the  coi’d,  since  they  arise  from 
the  spinal  nerves  themselves,  and  with  the  vaidous  visceral  plexuses,  also, 
which  rule  the  organic  life;  that  they  were  extremely  important  in  the  work 
of  the  Osteopath,  and  that  since  the  general  health  was  so  often  involved  in 
the  troubles  of  the  viscera,  therefore  he  worked  upon  them  very  frequently; 
the  fact  that  he  worked  usually  directly  for  the  benefit  of  the  action  he  would 
get  up  on  abdominal  life,  and  that  also  he  frequently  worked  in  a regulative 
way,  using  the  splanchnics  for  vaso-motor  control  largely,  thus  influencing 
arge  quantities  of  blood  and  drawing  them  from  parts  of  the  body  where  a 


127 


congestion  may  have  existed.  I spoke  in  general  also  concerning  congestion, 
and  the  way  we  treat  it.  I also  bionght  out  certain  landmarks  concerning 
the  thorax  and  certain  points  in  examination  of  the  jiarts  of  the  thorax.  1 
wish  to  continue  that  subject  to-day. 

I.  Landmarks  of  the  Thorax. — After  Holden:  The  interval  below 

the  clavicle  is  the  snb-clavicular  space  between  it  and  the  upper  margin  of 
the  pectoralis  major  and  the  deltoid  externally,  and  is  imiiortant  as  a guide 
to  us  to  find  the  coracoid  i^rocess.  By  drawing  the  arm  up  and  backward  in 
this  way,  thus  tensing  those  muscles,  we  can  feel  the  sub-clavicular  space, 
and  at  the  outer  part,  near  the  shoulder,  we  can  find  the  inner  side  of  the 
coracoid  process.  Also  that  space  corresponds  in  direction  to  the  direction 
of  the  axillary  artery,  we  can  feel  it  j)ulsiug  in  there,  and  can  comijress  it 
against  the  second  rib.  The  internal  mammary  artery  runs  perijeudicular  to 
the  cartilages  of  the  ribs,  and  about  half  an  inch  external  to  the  margin  of  the 
sternum.  Its  perforating  branch  at  the  second  intercostal  space,  is  the  chief 
one.  It  becomes  important  for  us  as  Osteopaths  in  examination  of  the  heart 
to  know  just  what  its  topogra^^hy  upon  the  chest  wall  would  be.  The  follow- 
ing description  of  the  outline  of  the  heart  on  the  chest  wall  is  given: 

That  the  base  corresponds  to  a horizontal  line  drawn  from  the  third  costal 
cartilages,  their  u^jper  border,  extended  a half  inch  to  the  right  and  inch  to 
the  left;  that  the  apex  is  found  by  measuring  one  inch  internal  and  two  inches 
below  the  nipple,  this  point  being  between  the  fifth  and  sixth  ribs:  that  the 
lower  margin  may  be  outlined  by  drawing  a line  from  this  j)oiut  of  the  aj)ex, 
bulging  slightly  downward  to  the  end  of  the  sternum,  the  xii^hoid  cartilage 
excepted,  that  line  extended  as  far  as  the  right  edge  of  the  sternum:  that  the 
right  border  would  therefore  be  indicated  by  a line  joining  point  at  the  right 
inferior  extremity  of  the  sternum  with  a point  on  a level  with  the  cartilages 
of  the  third  rib,  extended  half  an  inch  to  the  right,  while  on  the  left  the  bor- 
der would  be  indicated  by  a line  drawn  from  the  left  extremity  of  this  line  at 
the  base,  an  inch  and  a half  from  the  sternum  on  the  level  with  the  third 
costal  cartilage  down  to  the  point  which  indicates  the  apex.  In  that  way  you 
would  get  the  outline  of  the  heart  upon  the  chest  wall.  It  is  said  that  a needle 
passed  into  the  third,  fourth  and  fifth  intercostal  spaces  on  the  right  side  just 
next  to  the  sternum,  would  perforate  the  lung,  pericardium,  aud  the  right 
auricle.  A needle  passed  into  the  second  interspace  would  iterforate  the 
aorta  at  its  greatest  bulge,  also  the  part  of  the  ijericardium  which  is  refiected 
over  the  first  part  of  the  aorta.  And  that  a needle  perforating  the  first  inter- 
costal space  on  the  right  of  the  sternum  would  enter  the  suiierior  vena  cava. 

This  rule  is  given  for  finding  the  extent,  or  outlining  in  general  the  dull- 
sonnding  space  in  the  precardial  region  made  by  the  presence  of  the  heart: 
take  a point  midway  between  the  nipple  and  the  sternum,  a point  midway  for 
your  center,  and  describe  about  that  a circle  with  a diameter  of  two  inches. 


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and  that  will  include  practically  all  of  this  dull-sounding  region  over  the 
heart. 

The  apex  of  the  heart,  as  you  know,  beats  between  the  fifth  and  sixth 
ribs.  Its  impulse  is  readily  felt  there,  but  that  is  not  an  invariable  j)laee  to 
find  it.  You  can  change  the  position  of  the  heart  by  changing  your  position. 
You  may  cause  the  heart  to  deviate  from  its  usual  locus  by  turning  from  side 
to  side.  In  deep  inspiration  the  heart  may  descend  somewhat,  so  that  when 
you  have  taken  a very  deep  breath  you  may  feel  the  beating  of  the  heart  over 
the  pit  of  the  stomach.  That  is,  yon  can  get  the  impulse  at  that  place. 

As  to  the  valves  of  the  heart  and  their  location  externally:  The  aortic 

valves  are  located  behind  the  third  intercostal  space  close  to  the  left  border 
of  the  sternum;  the  pulmonary  valves  at  the  junction  of  the  third  costal 
cartilage  with  the  sternum,  on  the  left;  the  tricuspid  valves  are  on  a level 
with  the  cartilage  of  the  fourth  rib  just  behind  the  middle  of  the  sternum, 
and  the  mitral  valves  are  at  the  third  intercostal  space,  about  au  inch  to  the 
left  of  the  sternum.  Since  the  valves  are  close  together  they  are  readily  cov- 
ered by  the  tij)  of  the  stethoscope,  or  what  is  better  for  our  use,  by  the  ear. 
And  since  they  are  covered  by  a small  amount  of  lung  tissue  you  can  hear 
the  heart  better  by  having  the  patient  hold  the  breath  while  you  listen  to  the 
beating  of  the  heart.  For  the  reason  that  these  valves  are  so  close  together 
it  is  better  in  trying  to  distinguish  the  sound  from  each,  to  go  out  a little  way 
in  the  direction  of  the  current  from  the  ^alve.  Thus,  in  sounding  the  aortic 
valves,  you  would  go  to  the  second  intercostal  space,  just  at  the  right  edge  of 
the  sternum.  For  sounding  the  pulmonary  valves,  you  would  go  to  second 
intercostal  space  at  the  left  edge  of  the  sternum.  To  sound  the  tricuspids 
you  would  take  the  point  at  the  end  of  the  sternum  just  behind  the  middle, 
and  to  observe  the  sound  of  the  mitral  valves  you  would  listen  at  the  apex  of 
the  heart.  That  is  according  to  the  direction  that  the  blood  takes. 

For  finding  the  outline  of  the  lungs  upon  the  chest  wall:  You  know  that 

they  rise  above  the  clavicle  an  inch  and  a half,  or  in  some  cases  two  inches; 
that  there  is  but  very  little  lung  tissue  behind  the  first  j>art  of  the  sternum; 
that  from  the  sternal  articulation  down  to  about  the  second  rib,  the  anterior 
edges  of  the  lungs  converge.  From  the  second  to  the  fourth  they  are  close  to- 
gether in  the  median  line,  quite  close,  and  also  about  j)arallel.  Below  this 
point  their  course  on  the  different  sides  is  different.  On  the  right  side  it  fol- 
lows down  along  the  course  of  the  sixth  costal  cartilage.  On  the  left  it  is 
notched  for  the  heart,  descending  back  of  the  heart.  On  the  left  side  it  de- 
scends as  far  as  the  lower  border  of  the  fourth  rib,  which  it  follows.  It 
reaches  a line  drawn  perpendicularly  from  the  uii^iile,  at  the  lower  edge  of 
the  sixth  rib.  In  the  axillary  region  on  each  side  it  is  found  at  the  lower 
edge  of  the  eighth  rib,  and  behind,  extends  as  far  down  as  the  tenth  rib.  Of 
course  in  the  deep  inspiration  it  descends  still  lower. 


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II.  Examination  of  the  Thorax.  (Continued.) — I began  to  take  up 
tbis  examination  at  tbe  last  meeting.  I wish  first,  to  give  you  some  points 
concerning  the  divisions  of  the  thorax,  which,  while  they  are  not  of  so  much 
use  to  us  as  Osteopaths,  as  we  do  not  divide  the  thorax  into  such  spaces  in 
our  practical  work,  I thought  it  best  to  describe  them  to  you  for  the  sake  of 
your  understanding  them  when  you  come  across  them  in  your  reading,  so  that 
you  will  know  what  is  meant  by  the  mammary  region,  the  scapular  region,  etc. 
This  division  is  the  one  adopted  by  Loomis.  He  divides  the  chest  first  into 
three  general  regions,  the  anterior,  lateral,  and  posterior.  The  area  on  the 
anterior  aspect  is  again  divided  : The  supra-clavieular  portion  is  that,  in  gen- 
eral, just  above  the  clavicle.  The  clavicular  portion  is  that  corresponding  to 
the  inner  three-fifths  of  the  clavicle,  and  is  bounded  by  that  bone.  The  in- 
fraclavicular  space  extends  from  the  lower  border  of  the  third  rib ; internally 
it  is  bounded  by  the  edge  of  the  sternum,  and  externally  by  a perpendicular 
line  dropped  from  the  junction  of  the  middle  and  outer  third  of  the  clavicle. 
Next  below  comes  the  mammary  region,  extending  from  the  lower  bolder  of 
the  third  rib  to  the  lower  border  of  the  sixth  rib,  extending  inward  as  far  as 
the  edge  of  the  sternum,  and  outward  as  far  as  the  last  described.  Next,  as 
for  the  sternal  region:  There  is  the  suprasternal  region,  which  he  describes  as 
the  region  just  above  the  sternum.  The  superior  sternal  region  is  that  portion 
behind  as  much  of  the  sternum  as  lies  above  the  inferior  border  of  the  third 
rib  and  the  inferior  sternal  region,  that  behind  the  rest  of  the  sternum. 

On  the  posterior  aspect  we  have  three  regions  : The  supra-scapular,  and 

the  scapular,  corresponding  to  the  space  from  the  second  to  the  seventh  ribs 
inclusive,  and  corresponding  recpectively  to  the  supra-spiuatus  and  infra-spin- 
atus  fossae  of  the  scapula  extending  inward  in  this  region  as  far  as  the  inner 
or  spinal  edge  of  the  scapula,  and  extending  outward  as  far  as  the  axillary 
region.  The  infra-scapular  region  extends  from  the  lower  angle  of  the  scapula 
and  the  seventh  dorsal  vertebra  down  to  the  lower  margin  of  the  twelfth  rib ; 
extending  internallv  m this  case  to  the  spines  of  the  vertebra  and  externally  to 
the  inferior  axillary  region.  There  is  also  an  inter-scapular  region,  one  on 
each  side,  corresponding  to  tbe  space  between  he  second  and  sixth  ribs,  and 
between  the  inner  or  spinal  edge  of  the  scapula  and  the  spines  of  the  dorsal 
vertebrae.  Speaking,  bj^  the  way,  of  listening  io  the  sound  of  the  aorta,  it  is 
also  heard  in  the  posterior  region  of  the  back  from  the  third  down  to  the 
ninth  dorsal  vertebra. 

Laterally  we  have  the  axillary  space,  bounded  above  by  the  axilla  and  be- 
low by  a line  projected  from  the  mammary  space,  that  is,  from  the  inferior 
border  of  the  third  rib.  Then  we  have  the  infra-axillary  space,  extending 
from  the  axillary  space  above  down  to  the  lower  margin  of  the  12th  rib ; 
bounded  in  front  by  the  infra-mammary  region  and  posteriorly  by  the  infra- 
scapular  region. 


130 


You  know  already  as  far  as  practical  for  our  work  the  coutents  of  these 
different  regions,  especially  when  studied  in  conjunction  with  the  points  I 
have  already  given  you  in  these  landmarks.  As  I said,  I give  these  general  re- 
gions to  you,  not  to  detail  the  parts  found  in  them,  but  so  that  you  will  under- 
stand, when  an  author  speaks  of  these  general  regions,  what  he  is  speaking  of. 
You  are  of  course  aware  that  in  making  a physical  diagnosis,  of  which  our 
method  largely  consists,  and  which  our  medical  friends  seem  to  leave  out  in  a 
great  many  instances,  we  use  auscultation,  inspection,  percussion,  palpitation 
and  mensuration.  In  our  examination  we  want  to  hear  and  see  all  that  we  can 
that  is  going  on  about  the  human  body,  especially  in  toe  wa}’  of  examining 
and  making  out  things  which  have  caused  a departure  from  the  normal.  I 
mentioned  certain  points  at  the  last  lecture  in  relation  to  the  chest.  There  is 
another  point  that  I wish  to  speak  of  which  is  important  in  our  practice,  and 
that  is  the  movement  of  the  chest  as  to  whether  the  two  sides  correspond, 
whether  one  side  is  restricted  in  movement  as  in  the  ease  of  pneumonia  or 
whether  the  inferior  ribs  are  drawn  in  as  in  some  cases  of  asthma,  where  I 
have  seen  them  drawn  in  extensively.  Also  note  whether  or  not  the  action  of 
the  opposite  side  is  normal  or  increased  to  compensate  for  lack  of  normal  on 
the  other  side.  It  is  taken  as  a very  good  sign  of  tuberculosis  if  there  is  a 
depression  in  the  infra-clavicular  region.  A great  deal  more  might  be  said 
about  these  different  methods  of  physical  diagnosis,  but  it  is  hardly  the  place 
here  to  go  into  them  extensively.  In  considering  palpitation,  that  is  the  ex- 
amination on  the  surface  with  the  hand,  I brought  up  certain  points  last  time. 
We  should  not  only  touch  both  sides  of  the  thorax  in  making  the  examination, 
but  we  should  touch  with  equal  force  and  touch  in  the  same  place  each  time, 
and  you  need  not  lay  your  hand  on  heavily,  lightly  is  sufficient.  Auscultation 
and  percussion  are  by  far  the  most  important  methods  in  dealing  with  the 
chest,  especially  since  it  contains  the  heart  and  lungs,  and  to  get  a good  idea 
how  the  heart  and  lungs  are  behaving  we  must  listen  to  them  directly  and 
also  listen  to  them  by  percussing  the  region  in  which  they  lie.  The  authors, 
of  course,  have  different  methods  of  bringing  out  these  points.  I have  been 
reading  Loomis  and  he  seems  to  have  some  very  good  points.  Of  course  they 
all  make  this  statement,  that  percussion  is  either  immediate  or  mediate.  Im- 
mediate percussion  or  direct  tapping  upon  the  part  is  the  old  method  and  is 
very  little  used  nowadays.  The  mediate  style  is  the  one  used  most,  in  which 
you  use  a little  rubber  tipped  hammer  of  some  sort  as  you  percuss,  and  what 
is  known  as  a pleximeter  placed  between  the  hammer  and  the  part  sounded. 
That  is  very  rarely  used.  It  is  stated  by  some  authors  that  we  have  as  good 
instruments  as  necessary,  the  middle  or  index  finger  of  the  left  hand  being  the 
pleximeter  and  the  fingers  of  the  right  hand  being  the  hammer.  There  are 
certain  simple  rules  that  we  may  adopt  in  using  this  method  of  physical  diag- 
nosis. First,  it  will  be  of  little  value  to  you  to  find  a difference  in  sound  un- 


131 


less  both  sides  of  the  chest  or  of  the  part  of  the  body  which  is  bein^  examined 
are  similarly  disposed  so  that  one  is  not  in  a higher  plane  than  the  other.  You 
must  be  extremely  careful  of  the  position  of  the  patient.  Then,  also,  you 
should  have  the  parts  slightly  tensed.  For  instance  in  examining  the  chest 
the  arms  should  drop  downward  and  the  head  be  thrown  back.  If  you  are 
percussing  the  axillary  region  have  the  arms  lifted.  If  you  are  percussing  the 
back  have  the  patient  stoop  over  slightly  so  as  to  bring  tension  on  the  part  per- 
cussed. That  should  be  done  evenly;  a patient  should  not  have  one  arm  down 
and  the  other  over  the  head.  The  conditions  on  each  side  should  be  similar. 
It  is  well  to  make  the  examination  directly  upon  the  skin,  or  if  that  is  not 
practicable  make  it  upon  some  thin,  soft  cloth  spread  over  the  chest,  of  such  a 
nature  that  it  will  not  interfere  with  the  sound.  You  should,  of  course,  per- 
cuss equally  on  each  side,  and  in  case  of  the  lungs  you  should  take  it  at  the 
same  stage  of  respiration,  that  is,  you  should  not  tap  on  one  side  while  the  pa- 
tient is  inhaling  and  on  the  other  side  while  the  patient  is  exhaling.  You 
should  have  an  equal  pressure  with  the  pleximeter  finger  and  an  equal  forcible- 
ness  of  the  striking  hand,  because  you  can  make  the  sound  different  by  strik- 
ing harder  on  one  side  or  by  holding  the  hand  more  loosely  against  the  surface 
you  are  examining.  The  best  percussing  motion  comes  from  the  wrist  and 
not  from  the  whole  arm,  and  in  general  tap  lightly  for  an  examination  of  the 
superficial  parts  and  more  forcibly  for  parts  more  deeply  located. 

In  the  practice  of  auscultation  the  same  general  rules  will  apply  ; jmu  have 
the  immediate  in  which  you  apply  the  ear  directly  to  the  part,  or  jmu  have  the 
me'diate  in  which  you  use  some  instrument  as  a stethoscope.  The  authors  dif- 
fer a great  deal  as  to  whether  a stethoscope  should  be  used.  Loomis  is  par- 
ticular that  it  should  be  used  in  examining  the  heart  but  does  not  care  much 
for  it  in  examining  the  lungs.  Raue,  whom  I sometimes  read,  says  he  prefers 
in  all  cause  the  use  of  the  ear  alone  unless  considerations  of  cleansiness  make  it 
convenient  for  the  use  of  the  stethoscope.  If  you  are  axamining  the  chest  and 
it  is  covered  see  that  the  covering  is  a thin  soft  cloth,  a towel  will  usually  do. 
something  that  will  not  interfere  with  the  sound.  See  that  your  patient  is  in 
a proper  condition  with  both  parts  disposed  alike,  and  give  your  full  attention 
to  the  sound  itself.  The  ear  should  be  evenly  applied  in  each  case  alike,  not 
forceably  but  firmly.  You  should  listen  to  the  corresponding  parts,  and  in 
touching  you  should  touch  over  the  corresponding  parts,  for  instance  it  would 
not  do  to  tap  over  a rib  on  one  side  and  over  the  interspace  on  the  other.  You 
must  examine  the  corresponding  parts,  no  matter  how  you  do  it,  and  then,  of 
course,  especially  in  respiration,  it  is  better  to  examine  under  conditions  as 
nearly  normal  as  possible,  have  the  patient  breathing  qnieth"  and  in  a natural 
way. 

I mention  these  things  to  you  more  for  the  sake  of  a hint  of  what  there  is 
in  this  subject  and  what  there  is  for  you  to  study,  since  it  is  quite  a complex 


132 


subject  to  go  in  detail  over  tbe  diffei'ent  sounds  that  you  will  bear,  and  to  do  so 
would  probably  confuse  you  more  than  elucidate  tbe  subject.  Also  it  is  very 
difficult  to  show  these  things  without  clinic  material,  and  you  can  only  learn 
them  by  practice.  You  should  become  perfectly  familiar  with  the  sound  of 
the  normal  parts  both  on  auscultation  and  percussion,  and  then  you  will  note 
any  departure  from  the  normal  when  you  come  to  make  examinations,  and  also 
to  distinguish  the  different  abnormal  sounds  one  from  another.  However,  this 
is  quite  an  imporant  subject.  I would  advise  you  to  become  familiar  with  the 
instrument  that  you  are  going  to  use.  I do  not  think  it  is  generally  recom- 
mended that  the  Osteopath  should  use  a stethoscope.  That  is  a matter  of  taste. 
The  way  is  to  get  familiar  with  the  sounds  by  the  ear  if  you  are  going  to  use 
the  ear,  or  familiar  with  a certain  stethescope,  as  the  sounds  vary  with  different 
instruments. 

III.  How  TO  Exaimine  for  Displaced  Ribs.  I examined  the  different 
parts  of  the  thorax  at  the  last  time.  In  the  first  place,  I need  hardly  to  remind 
you  that  in  variations  in  the  spine,  any  abnormal  curve  in  the  spine,  either 
curvature  or  departure  from  the  normal  curves,  will  tend  to 
alter  the  normal  position  of  the  ribs.  So  that  in  examining  the 
spine  if  you  find  that  the  parts  are  not  in  normal  position,  of  course 
you  will  at  once  look  for  dislocations  in  the  ribs  corresponding  with  the  affected 
part  in  the  spine,  to  see  whether  or  not  the  affection  has  extended  that  far. 
You  may  find  a general  alternation  in  the  shape  of  the  chest,  as  for  instance  the 
flattening  in  the  paralytic  chest  in  its  anter-posterior  diameter ; or  flattening  in 
lateral  in  rachitis,  or  bulging  or  barrel  shaped  chest  in  asthma  or  emphysema. 
Of  course  you  will  then  see  at  once  that  there  is  a change  not  only  in  the  thorax 
in  general  but  in  the  parts  necessarily,  and  that  you  will  probably  find  that  the 
ribs  are  misplaced.  To  examine  and  replace  subluxated  or  displaced  ribs  is  one 
of  the  most  important  parts  of  our  practice,  not  only  because  it  occurs  so  fre- 
quently but  because  it  is  very  troublesome.  They  often  cause  serious  trouble 
and  are  hard  to  locate  in  some  instances,  they  will  require  your  very  careful  at- 
tention. We  might  explain  why  it  is  that  ribs  when  displaced  cause  so  much 
ti’ouble.  I think  the  theory  already  advanced  will  explain  that  as  far  as  it  goes, 
that  is,  parts  out  of  the  normal,  whether  they  be  ribs  or  vertebrm,  will  bring 
pressure  in  some  cases  npon  structures  such  as  nerves  and  blood  vessels ; in 
other  cases  they  would  drag  ligaments  across  important  structures.  In  other 
cases  they  may  result  in  contractures  and  that  will  be  followed  by  other  results 
already  noted.  So  in  examining  a spine  and  the  chest  particularly  you  should 
examine  each  rib.  I have  already  given  you  the  rules  for  counting  the  ribs, 
and  having  found  where  each  rib  is  you  should  examine  each  rib  in  particular. 
It  is  said  where  a rib  is  displaced  you  will  very  likely  find  tender  points  along 
its  course.  Dr.  McConnell  says  that  usually  there  is  a tender  point  at  the  spine 
where  it  is  displaced,  another  about  the  middle  region  and  another  at  the  an- 


138 


terior  end.  Yon  will  also  lind  cases  where  they  are  sore  almost  all  the  way 
along,  especially  the  anterior  half. 

The  ribs  may  be  pressed  together  behind  and  separated  in  front.  In 
general  you  will  look  for  the  soreness  over  the  rib  and  over  the  part  of  the 
interspace  which  is  narrowed.  I have  found  that  to  be  so  in  my  exj^erience 
at  least.  The  displaced  rib  may  be  separated  from  one  rib,  w'hich  naturally 
causes  it  to  be  approximated  to  some  other  rib,  and  you  will  judge  which  it 
is  by  finding  the  widening  above  and  the  narrowing  below,  for  any  one  rib  or 
any  group  of  ribs.  Then  your  rib  may  be  changed,  not  being  slipped  up  or 
down,  but  may  be  twisted  so  that  you  will  find  that  one  edge  is  more  promi- 
nent, and  in  this  case  it  is  very  common  to  find  the  under  edge  the  most 
prominent.  The  best  method  that  I have  found  to  examine  whether  the  ribs 
are  separated  is  to  take  the  tips  of  the  fingers  and  follow'  dowm  the  course  of 
the  intercostal  spaces.  You  can  then  learn,  knowing  the  normal,  whether  or 
not  these  parts  are  too  much  separated  or  too  close  together;  you  will  also 
note  whether  or  not  they  are  not  twisted.  Sometimes  the  cartilages  will  be 
distorted,  and  in  that  case  you  wTll  find  an  irregularity  and  a tenderness 
along  them.  They  may  be  twisted  or  may  have  been  torn  and  grown  to- 
gether. I have  seen  several  cases  in  which  the  cartilage  had  been  broken 
away  from  the  tenth  rib  and  the  person  had  three  floaters  on  each  side  in- 
stead of  two.  It  is  said  to  be  a fact  that  there  is  a little  weaker  attachment 
of  the  cartilages  to  the  ends  of  the  ribs  in  the  case  of  the  tenth  than  in  the 
case  of  the  other  ribs.  In  examining  the  ribs  of  the  patient  what  I have  said 
will  apply  to  all  of  the  ribs,  but  of  course  w'e  must  appl5'  our  examination  to 
all  parts  of  the  thorax,  anterior  and  posterior.  But  in  examining  the  first 
and  second  ribs  you  wfill  find  that  something  more  of  a consideration.  The 
first  and  second  ribs,  on  account  of  their  attachment  to  the  scaleni  mus- 
cles are  usually  displaced  upward  because  the  tendency  of  these  muscles  when 
contracted  is  to  draw  the  ribs  upwmrd.  In  the  first  place,  how'  would  you 
tell  whether  or  not  this  first  rib  is  up"?  To  find  it  you  feel  down  about  the 
middle  point  of  the  clavicle,  press  dowm  and  back  and  you  will  immediately 
come  to  the  first  rib.  Y^ou  must  first  know  that  the  clavicle  itself  is  in  posi- 
tion. If  its  acromial  and  clavicular  are  both  in  situ  then  you  can  judge  from 
the  relative  position  of  the  first  rib  whether  it  is  up  or  down.  Of  course  the 
more  it  is  slipped  up,  the  more  it  tends  to  come  on  the  level  wTth  the  upper 
ridge  of  the  clavicle,  or  if  it  is  dowm  it  will  widen  the  space  between  them. 
That  is  one  of  the  best  ways  of  determining  by  examination  whether  it  be  up 
or  down.  The  second  rib  is  somewhat  more  difficult  to  get  at.  You  can  feel 
it,  as  I noted,  in  the  outer  portion  of  this  infra-clavicular  space  by  drawing 
the  arm  outward  and  down  tensing  the  muscle.  Y"ou  can  also  examine  it  by 
finding  the  junction  of  the  first  and  second  parts  of  the  sternum;  follow  the 
cartilage  out,  you  can  feel  it  as  far  as  the  clavicle.  Yote  whether  the  points 


V 


134 

are  sore  at  the  places  where  you  can  reach  the  rib,  and  by  following  further 
there  will  be  a difference  in  the  intercostal  space,  and  you  can  tell  whether 
the  second  rib  is  up  or  do’wn,  but  it  will  require  practice  and  I will  promise 
you  that  the  first  and  second  ribs  are  very  hard  to  deal  with.  Just  as  the 
hrst  two  ribs  are  usually  up,  the  last  two  by  some  strange  compensation  of 
nature,  go  down.  As  the  man  said,  ‘‘There  is  compensation  in  everything; 
snow  conies  down  in  winter  and  ice  goes  up  in  summer.”  The  reason  why 
these  last  two  ribs  go  down,  especially  the  last  one,  is  that  the  quadratus 
lumborum  muscle  is  attached  to  it,  and  it  seems  to  be  the  nature  of  the 
eleventh  to  follow  the  twelfth  in  its  course  downward,  I do  not  know  just  why, 
unless  it  is  because  it  is  not  attached  by  a cartilage  to  the  others  above,  and 
is  free  to  follow  the  other.  The  iiosition  of  these  ribs  is  very  readily  ascer- 
tained even  in  a fleshy  person.  It  will  take  considerable  dexterity  of  touch 
to  accustom  you  to  And  them,  but  by  patience  you  can  do  it.  Of  course  any 
of  these  ribs  may  not  only  be  slipped  up  or  down,  but  one  may  overlap  the 
other.  I saw  a case  the  other  day  in  which  the  tenth  was  overlapping  the 
eleventh  quite  prominently.  Then,  you  may  And  that  these  last  two  floating 
ribs  instead  of  being  dovm  may  be  up,  and  the  twelfth  may  be  pushed  up 
under  the  eleventh.  In  that  case  they  often  cause  trouble,  but  they  may 
sometimes  be  down  without  any  trouble  at  all,  in  which  case  it  will  not  be 
necessary  for  you  to  bother  with  them. 

I wish  to  tell  you  how  to  set  this  clavicle.  I noted  it  in  the  examination 
the  last  time.  Suppose,  in  the  first  place,  it  is  down.  It  may  be  down  at 
either  end.  I believe  the  commonest  place  for  it  to  be  down  is  at  the  outer 
end,  because  of  the  attachment  of  the  deltoid  and  of  the  pectoralis  major  to  it 
at  the  outer  end.  The  way  the  “Old  Doctor”  told  me  to  treat  that  is  to  get 
the  Angers  against  the  anterior  edge  of  the  clavicle  near  the  sternal  end,  draw 
the  arm  then  inward,  across  the  chest  thus  relaxing  the  ligaments  and  the 
muscles.  Then  push  outward  upon  the  first  point  that  I noted,  the  anterior 
edge  of  the  clavicle,  push  outward,  and  draw  the  arm  up  backward.  Thus 
having  relaxed  the  ligaments  and  muscles,  your  push  will  serve,  on  account 
of  the  peculiar  shape  of  the  clavicle,  to  push  it  on  to  its  proper  articulation. 
In  case  it  is  slipped  up  at  the  acromial  articulation,  that  sometimes  happens 
and  causes  a catching  of  the  fibers  of  the  deltoid,  or  it  impinges  on  the  fibers 
of  the  brachial  plexus,  the  best  way  is  to  raise  the  arm  to  relax  aU  muscular 
tension,  since  it  is  bound  to  the  shoulder  here  by  the  deltoid  partly,  and 
some  of  these  smaller  muscles;  relax  them  in  that  way.  and  then  you  can  get 
your  Angers  in  behind  the  part  that  is  slipped  up,  and  it  does  not  make  much 
difference  which  way  you  throw  the  arm.  Dr.  Harry  says  when  a joint  is 
out  almost  any  way  you  turn  it,  it  will  want  to  pop  back  where  it  belongs, 
which  of  course  is  true,  that  is  the  tendency  toward  the  normal.  In  case  it  is 
down  at  the  sternal  end,  which  you  And  with  a fair  degree  of  frequency,  one 


135 


of  the  best  ways  is  to  thrust  the  thumb  of  oue  hand  tinder  in  behind  the 
sternal  end  of  the  clavicle,  thrust  it  in  deeply,  and  then  relax  the  muscles  by 
drawing  the  arm  up  and  inward.  Then  by  drawing  the  arm  over,  down  and 
out  and  thus  tensing  the  muscles,  it  brings  a leverage  upon  that  end  of  the 
clavicle,  and  will  force  it  up.  Or  you  do  practically  the  same  thing  by  bring- 
ing the  arm  up  and  around  and  making  a twist  in  such  a way  as  to  tense  the 
muscles.  In  other  words,  this  is  just  a system  of  animal  mechanics  whereby 
you  study  out  the  shape  of  the  bones,  their  attachments  and  ligaments,  and 
attachment  of  the  muscles,  and  just  how  to  use  these  ligaments,  bones  and 
muscles,  as  levers  and  pulleys,  so  as  to  work  them  back  into  place.  Xow,  if 
the  clavicle  is  up,  the  point  of  course  would  be  to  relax  again  and  simi)ly 
force  it  down  from  above  by  working  with  the  thumb  in  behind  it.  Another 
good  way  to  free  up  the  space  between  the  clavicle  and  the  first  rib  is  to  thrus; 
the  fingers  in  behind  the  clavicle  where  it  is  always  tender,  and  draw  the  arm 
up  over  the  face  and  then  on  out,  thus  getting  a very  good  leverage. 


LECTUEE  XXI. 

At  the  last  lecture  I took  up  certain  landmarks  of  the  thorax,  showing 
you,  among  other  things,  what  was  the  outline  upon  the  chest  wall  of  the 
heart,  where  to  note  its  valves,  and  where  to  listen  to  the  sounds  produced 
by  their  action;  that  the  point  at  which  you  should  listen  varies  from  the 
position  of  the  valve  in  the  direction  of  the  current  of  blood.  Also  I noted 
the  topography  of  the  lung  upon  the  chest  wall.  Then  I took  up  certain 
points  in  the  examination  of  the  thorax,  showing  you  how  it  was  divided  into 
the  different  regions;  then  spoke  concerning  auscultation,  i^alpation,  mensura- 
tion, percussion,  etc.,  the  different  methods  that  we  use.  Then  I brought  uj) 
the  point  of  how  to  examine  for  displaced  ribs.  To-day  I wish  to  take  uj) 
more  particularly  the  contents  of  the  thorax,  viz.,  the  heart  and  lungs.  They 
are,  of  course,  important  to  the  Osteopath,  and  since  they  have  so  much  to  do 
with  life,  they  must  be  carefully  looked  after.  I think  that  the  Osteopath  has 
more  success  than  other  forms  of  healing  with  troubles  iu  the  heart  and  lungs. 
A great  many  troubles  of  the  heart  are  not  organic,  and  when  not  organic  the 
opportunities  for  Osteopathic  work  are  much  better  than  when  organic. 

I.  Some  Centers  and  Nerve  Connections  for  the  Heart  and  Lungs: 
There  are  certain  facts  that  we  come  across  in  our  osteopathic  work  which  lead 
us  to  reason  about  nerve  action.  In  the  first  place,  displaced  ribs  will  very 
readily  affect  the  heart.  Sympathetic  troubles,  such  as  crying  and  the  like, 
are  caused  by  contractures  along  the  left  side  of  the  back  between  the  shoul- 
ders, or  by  displacements  in  that  region  ; displacements  of  the  third,  fourth  and 
fifth  ribs  particulaily.  From  the  fact  that  we  can  reach  the  heart  through  the 
superior  cervical  ganglion  and  in  the  upper  dorsal  region  on  the  left  side,  and 


from  the  fact  that  there  are  certain  centers  given,  as  that  in  the  medulla,  and 
for  the  rhythm  of  the  heart  in  the  upper  dorsal  region,  from  the  second  to  the 
fourth,  we  naturally  wish  to  know  what  is  the  nerve  connection,  and  why  it  is 
that  working  there  we  can  get  such  an  important  effect  upon  the  heart.  That 
we  do  get  these  effects,  of  coarse  our  practice  shows,  it  is  simply  a question  of 
fitting  theories  to  these  facts.  In  the  first  place,  we  sometimes  work  along 
the  splanchnics,  and  thus  get  an  effect  upon  the  centers,  which  I explained  at 
length  in  the  lecture  the  other  day.  Then  there  is  our  work  in  the  upper  dor- 
sal regiou.  Those  are  the  two  places,  except  the  neck,  where  we  get  the  most 
important  effects.  Now,  as  to  this  nerve  connection  between  the  heart  and  the 
spine,  Jacobson  brings  out  the  connection  here  very  admirably,  in  relation  to 
the  infra-mammary  pains.  He  shows  how  the  viscera  are  connected  through 
the  sympalhetics,  the  great  splanchnic  particularly,  connected  with  the  spine 
as  high  as  the  fourth,  fifth  and  sixth  spinal  nerves.  We  have  learned  that  the 
great  splanchnic  may  arise  as  high  as  the  third  also.  These  spinal  nerves  send 
certain  sympathetic  branches  to  the  aorta,  from  the  fourth,  fifth  and  sixth  sym- 
pathetic ganglia,  branches  are  given  off  which  form  a plexus  about  the  aorta. 
This  plexus  over  the  aorta  gives  branches  to  the  cardiac  plexus  about  the  heart. 
Further,  there  are  branches  given  off  from  the  fourth,  fifth  and  sixth,  cutane- 
ous branches,  descending  over  the  ribs  and  supplying  parts  along  the  sixth,  sev- 
enth and  eighth  ribs.  Hence  you  have  a direct  connection  between  the  pain 
which  you  feel  by  means  of  these  cutaneous  nerves  of  the  sixth,  seventh  and 
eighth  interspace  which  run  in  their  distribution  beneath  the  breast,  in  the 
infra-mamraarv  region,  a connection  with  the  spinal  nerves  and  thus  with  the 
fourth,  fifth  and  sixth  spinal  nerves,  and  through  them  out  to  the  sympathetic 
plexuses  about  the  aorta  and  the  heart.  Thus,  you  have  an  indirect  connection 
between  the  viscera  on  the  one  hand,  and  the  heart’s  action  cn  the  other.  You 
may  have  pains  in  the  infra-mammary  regiou  caused  by  diseases  of  the  heart. 
Hilton,  himself,  also  states  something  concerning  the  sympathetic  pains  which 
we  may  feel  on  the  surface  of  the  body.  That  pains  from  diseased  viscera,  the 
liver  or  intestines,  for  instance,  are  often  reflected  to  the  region  between  the 
shoulders  or  at  the  inferior  angles  of  the  scapula.  You  can  readily  see  how 
this  connection  takes  place,  between  the  sympathetics  from  the  great  splanch- 
nics and  those  of  these  fourth,  fifth  and  sixth,  and  directed  to  the  region  of  the 
scapulse  and  the  region  between  them  and  about  their  angles.  Thus  we  see  how 
we  may  have  pain  in  a distant  part  of  the  body  when  a certain  terminal  is 
affected.  I have,  myself,  noticed  in  certain  cases  of  trouble  with  the  liver, 
where  the  liver  was  rather  tender,  that  I could  get  a pain  under  the  scapula, 
especially  on  the  left  side. 

Taking  into  consideration  the  connection  between  the  heart  and  this  upper 
dorsal  region,  the  fourth,  fifth  and  sixth,  you  can  see  how  the  Osteopath,  by 
workino'  there,  where  he  does  very  frequently  to  affect  the  heart,  can  get  an 


137 


effect  upon  the  heart,  and  thus  upon  the  general  circulation.  I think  I instanced 
the  point  that  by  working  along  the  splanehnics  and  by  working  along  the 
upper  dorsal  region,  I could  get  important  effects  in  quieting  the  heart.  I have 
sometimes  quieted  the  heart  as  much  as  from  ten  to  twenty  beats  per  minute, 
when  it  was  running  high  by  work  in  this  region.  Thus  you  will  see  that 
work  here  upon  the  heart  is  directly  upon  nerve  action,  but  we  must  not  omit 
to  notice  the  fact  that  by  raising  the  ribs  we  get  a mechanical  effect,  if  those 
ribs  were  so  lowered  as  to  narrow  the  cavity  in  which  the  heart  acts.  Any  les- 
lesing  of  that  cavity  has  a tendency  to  interfere  with  the  heart’s  beat,  so  that 
by  mechanically  enlarging  the  cavity  we  also  get  an  effect  upon  the  heart.  It 
is  probable  also  that  the  raising  of  the  ribs  frees  pressure  upon  nerve  connec- 
tions along  the  spine. 

Further,  as  to  connections  in  the  upper  dorsal  region  between  the  nerves 
there  and  the  heart,  Quain  says,  that  accelerator  fibers  of  the  heart  derived 
from  the  upper  four  or  five  dorsal  nerves,  but  chiefly  from  the  second  and  third, 
are  sometimes  found.  The  spinal  fibers  begin  in  the  middle  and  lower  cervical, 
perhaps  also  the  first  thoracic  ganglion.  That  is,  these  fibers  really  come  from 
the  sympathetics,  the  change  of  fibers  occurring  in  the  ganglion  mentioned.  He 
says  further,  that  vaso-constrictor  fibers  of  pulmonary  vessels  have  been  found 
in  the  dog  from  the  second  to  the  seventh  spinal  nerves,  and  that  they  connect 
in  the  stellate  ganglion.  In  the  dog  and  eat  it  is  said  that  the  lower  cervical 
and  upper  thoracic  ganglia  are  connected  to  form  what  is  called  the  stellate 
ganglion.  While  it  has  not  been  demonstrated  in  man  that  these  fibers  arise 
from  the  second  to  the  seventh,  these  vasu-contrictors  foi  the  pulmonary  ves- 
sels, it  looks  probable  that  there  are  some  such  fibers  existing,  since  that  is  the 
identical  center  upon  which  we  work  to  affect  the  lungs,  the  second  to  the  sev- 
enth dorsal.  Howell’s  Text  Book  states  that  stimulation  of  the  vagus  in  the  neck 
constricts  the  pulmonary  vessels,  while  stimulation  of  the  sympathetics  of  the 
neck  wdll  dilate  the  pulmonary  vessels;  also  that  there  is  noted  a reflex  con- 
traction of  the  pulmonary  vessels  by  stimulation  of  some  other  nerve,  as  for 
instance,  the  sciatic,  intercostal  nerves,  abdominal  pneiimogastric.  or  ab- 
dominal sympathetics.  This  will  call  to  your  mind  instantly  what  I have 
said  concerning  regulative  processes,  in  our  work  upon  different  parts  of  the 
body.  I mentioned  that  particularly  in  relation  to  the  splanehnics;  you  see 
the  reflex  effect  gained  by  stimulation  of  these  nerves  in  distant  parts  of  the 
body,  and  its  effects  upon  the  lungs.  You  see  how  general  that  work  may 
become.  It  is  an  interesting  fact  to  note  what  Robinson  says  concerning  the 
heait  and  the  aorta,  which  are  directly  connected  with  the  circulatory  system. 
He  says  that  they  have  been  noted  at  times  to  have  periods  of  violent  rapid 
beating,  and  that  the  heart  itself  and  the  aorta  appears  to  be  dilated  and  to  be 
working  very  forcibly;  that  feeling  of  the  pulse  in  other  j)arts  of  the  body 
would  not  indicate  that  the  effect  wms  general.  Robinson  says  that  this  has 


138 


been  little  made  of  in  books,  in  fact,  he  does  not  know  that  it  is  mentioned 
except  something  about  the  aorta,  and  explains  it  by  influence  of  one  kind  or 
another  which  may  effect  the  various  sympathetic  centers.  And  in  ease  of 
the  aorta  he  says  he  has  seen,  in  case  of  a thin  woman,  it  beating  violently 
and  simulating  in  every  respect  an  aneurism.  He  explains  it  by  saying  that 
the  centers  in  the  substance  or  in  the  immediate  neighborhood  of  the  aorta, 
are  in  some  way  affected,  though  the  effect  may,  of  course,  be  depeudent  upon 
general  conditions. 

II.  Examination  of  the  Heart. — First,  some  general  points  as  to  the 
heart.  The  ‘‘Old  Doctor”  explains  some  of  his  recent  illness  by  a stopxiage 
of  the  aorta  at  the  point  where  it  perforates  the  diaphragm.  He  says  that 
frequently  some  injury  there  may  cause  a constriction,  especially  if  the  injury 
is  of  such  a kind  as  to  allow  a relaxation  of  the  usual  vault  of  the  diaiihragm, 
causing  a constriction  about  the  jioint  where  the  aorta  passes  through,  and 
thus  constricting  and  restricting  the  blood  flow.  Thus,  he  says,  the  heart 
goes  to  work  pounding  to  force  the  blood  through,  and  you  have  palpitation 
of  the  heart.  That  is  similar  to  effects  we  have  in  other  parts  of  the  body, 
where  a thickening  of  jiarts  about  an  important  structure  would  lead  to 
troubles  which  were  of  peculiar  significance  to  the  Osteopath.  So  the  “Old 
Doctor”  wears  a belt.  He  says  that  compresses  the  lower  part  of  the  thorax, 
allows  the  aorta  to  bulge  upward. 

Second,  as  to  your  examination.  You  must  take  into  consideration  that 
the  heart,  being  so  closely  connected  with  sympathetic  life  in  every  part  of 
the  body,  is  affected  by  general  sympathetic  disturbances.  You  may  have 
trouble  almost  anywhere;  in  the  neck  or  with  the  genital  organs;  and  of 
course  you  get  an  important  effect  upon  the  heart  and  circulation  by  dilation 
of  the  rectal  sphincters.  Such  a slight  cause  as  a dropping  of  the  acromial 
end  of  the  clavicle,  or  either  end  of  the  clavicle,  for  that  matter,  shutting 
down  upon  the  circulation  through  the  subclavian  artery  and  vein,  generally 
the  vein,  has  caused  angina  pectoris.  I knew  of  a very  bad  case  where  the 
woman  was  ready  to  die  of  heart  trouble  and  looked  about  as  bad  as  a person 
could  look.  She  was  cured  by  the  “Old  Doctor”  by  setting  the  clavicle.  It 
was  a tj’pical  case,  with  the  radiating  pains  over  the  chest  and  all  the  accom- 
panying symptoms.  That  lady  is  one  of  our  graduates  now  and  enjoying  a 
lucrative  practice.  Also  the  same  kind  of  a slip  may  cause  a periodic  em- 
ptying of  the  innominate  vein,  and  thus  lead  to  a loss  of  a beat  of  the  heart 
occasionally,  so  that  the  heart  will  be  beating  irregularly.  So  please  consider 
that  in  looking  for  trouble  with  the  heart,  you  will  need  to  examine  not  only 
the  region  of  the  thorax,  but  everything  that  might  affect  the  vessels  coming 
from  it.  Do  not  forget  the  clavicle  or  the  first  and  second  ribs.  The  first 
and  second  ribs  are  apt  to  cause  troubles  of  the  heart.  The  reason  seems  to 
be  that  since  they  are  usually  disiilaced  upward,  they  bring  pressure  upon 


139 


some  of  the  blood  vessels  or  interfere  at  the  spine  with  some  of  the  important 
nerves  which  I mentioned  in  the  previous  part  of  my  lecture.  I do  not  know 
but  that  it  should  be  as  much  a matter  of  pride  with  us  to  observe  a profes- 
sional demeanor  in  our  calling  upon  a patient,  as  it  is  with  our  medical 
friends.  I have  gone  with  a student  to  see  a patient  where  there  was  trouble 
with  the  heart^ — I remember  one  case  particularly,  a case  of  asthma.  I went 
in  and  felt  the  pulse  the  first  thing,  as  I usually  do;  the  heart  was  beating  at 
the  rate  of  120  per  minute,  and  the  student  had  not  noticed  it.  So  it  will  not 
be  a bad  idea  to  always  note  the  pulse.  It  is,  of  course,  an  important  clue 
to  the  state  of  the  circulation.  It  will  tell  you  whether  or  not  the  heart  is  in- 
termitting; whether  or  not  the  heart  is  beating  too  strongly  or  too  weakly; 
’ . liether  or  not  the  pulse  is  normal  in  every  respect.  The  strength  of  the  beat 
you  can  tell,  then,  and  the  frequency  and  the  regularity'.  So  I always  first 
lake  the  pulse,  which  is  usually  found  best  at  the  left  wrist  at  the  radical 
firtery;  you  all  know  how  to  find  it.  Also  note  the  chest,  the  shape  of  it.  In 
enlargement  of  the  heart  there  may  be  a bulging  in  the  jjrecordial  region.  Or 
narrowing  of  the  chest  may  interfere  with  the  heart.  Do  not  forget  inspection 
of  the  chest  in  examination  for  troubles  of  the  heart.  Aote  also  by  inspection 
ami  by  paljjation  whether  the  apex  beat  is  normal,  occurring  at  the  inter- 
space between  the  fifth  and  sixth  ribs.  You  can,  by  knowing  how  it  beats 
normally,  tell  when  it  has  departed  from  the  normal,  whether  it  beat  too 
strongly  or  weakly.  Or  it  may  be  disijlaced  to  one  side  or  the  other  by 
troubles  of  the  other  viscera,  the  lungs,  for  instance.  Yotice  by  inspection 
and  palpation  where  the  ai)ex  beat  occurs.  By  palpation,  not  only  at  the 
apex  but  over  the  region  of  the  heart,  preferably  with  the  patient  sitting  up. 
you  can  note  the  three  i^oints  that  you  want,  that  is,  regularity,  frequency 
and  strength  of  the  beat.  It  is  not  a bad  point  in  examining  for  enlargement 
01'  encroachment  of  other  solid  viscera  upon  the  heart,  to  use  percussion.  It 
is  as  well  to  percuss  next  to  the  skin,  or  through  some  soft  thin  cloth.  The 
best  way  to  make  a pleximeter  of  your  left  hand  is  by  laying  not  the  whole 
jialm  of  your  hand,  but  just  the  middle  finger  upon  the  surface  to  be  per- 
cussed, and  then  striking  it  with  the  tips  of  the  fingers  of  the  right  brought  in 
line,  or  by  the  first  or  index  finger.  Of  course  when  you  come  to  the  heart 
you  note  its  flat  sound.  I noted  to  you  the  atlier  day  how  to  find  that  region, 
a circle  drawn  two  inches  about  a point  midway  between  the  nipple  and  the 
end  of  the  sternum. 

Dr.  Sheehan  called  my  attention  to  a point  the  other  day:  In  making 

percussion  over  the  parts  of  the  lungs  which  are  most  liable  to  be  affectetl  in 
tuberculosis,  make  it  light  because  there  is  some  danger  of  starting  a fresh 
hemorrhage  if  you  use  forcible  percussion.  Light  percussion  is  as  effective 
as  is  forcible.  Of  course  this  fiat  sound  of  the  heart  may  vary,  as  for  in- 
stance in  emphysema  it  may  become  resonant.  Or  it  may  be  increased  by 


140 


some  effusion  in  the  pericardium,  or  some  effusion  in  the  pleura  or  some  en- 
largement of  the  stomach  upward,  or  by  solidification  of  the  lung,  anything 
that  will  make  a larger  area  of  the  fiat  sound  in  the  region  of  the  heart.  By 
studying  these  things  they  will  be  an  important  aid  to  your  diagnosis. 

We  also  practice  auscultation  upon  the  heart,  by  placing  the  ear  over  the 
region  of  the  heart.  This  is  the  best  method  of  examining  the  heart.  You 
will  want  to  note  the  sounds  of  the  heart  particularly,  and  for  doing  that  you 
would  have  to  know  the  sounds  for  the  various  valves  of  the  heart.  Of 
course  there  are  various  murmurs,  regurgitant,  restrictive,  etc.  There  are 
rnui'inurs  that  occur  in  several  conditions  of  the  heart.  Sometimes  there  is  a 
venous  murmur,  as  in  the  jugular  vein.  It  is  said  that  by  holding  that  vein, 
and  compressing  it  for  a few  minutes  you  can  stoi^  that  hum.  To  differentiate 
between  it  and  the  heart  murmur,  particularly  that  caused  by  percussion  of 
the  heart  against  the  pericardium  when  it  has  been  thickened  by  some  in- 
fiammatory  process,  is  difficult.  It  is  also  difficult  to  differentiate  from  other 
murmurs  in  the  heart,  and  the  only  way  is  to  find  that  this  sonnd  follows, 
while  the  other  accompanies  the  heart  beat. 

A great  deal,  I am  aware,  might  be  said  about  physical  examination  of 
the  heart,  about  the  analysis  of  these  sounds,  biit  should  I go  into  that  sub- 
ject extensively  it  would  make  a set  of  lectures  as  large  as  that  I am  deliver- 
ing in  general.  It  is  only  by  study  along  those  lines  and  by  practice  that 
you  will  learn  both  the  normal  and  abnormal.  But  I brought  them  up  for 
your  notice,  and  leave  them  for  the  more  important  part,  the  osteopathic 
practice,  which  I shall  consider  here. 

III.  Examination  of  the  Lungs. — We  adopt  the  same  methods  for 
percussing  the  different  regions  of  the  chest.  For  instance,  if  you  were 
sounding  here  over  the  clavicle,  you  get  a dull  sound;  while  in  the  space  just 
below  we  should  get  a resonant  sonnd;  over  the  larynx,  especially  with  the 
mouth  open,  you  get  a higher  sound,  called  Wmpanitie.  You  must  become 
accustomed  to  these  normal  sounds.  Anything  which  will  cause  a solidifica- 
tion of  the  lungs  about  the  tubes  or  thickening  of  the  tubes  themselves,  in 
fact,  an  accumulation,  or  any  growth  which  aids  transmission  of  sounds  will 
change  the  character  of  these  sounds,  making  them  more  resonant,  higher; 
while  the  effusion  of  any  liquid,  such  as  blood  in  hemorrhage,  or  in  the  case 
of  pleurisy  the  effusion  of  lymph  or  serum,  or  the  accumulation  of  pus  will 
also  interfere  with  the  sound  and  make  it  more  dull.  There  is  a tympanitic 
sound  found  in  the  lung  when  there  is  a large  cavity  not  communicating  with 
a brochus;  when  the  cavity  communicates  with  a bronchus  we  get  what  is 
called  the  “cracked-pot  sound.”  Our  chief  methods  of  examining  the  lungs 
are  by  percussion  and  auscultation;  these  are  two  of  the  best  methods.  I am 
aware  that  this  subject  under  my  treatment  is  a very  dull  subject  to  you. 
However,  it  will  be  a very  imiiortant  one  and  will  merit  further  study.  If  I 


141 


had  the  time  and  ability  to  go  into  tlie  subject  more  fully  I vould  spend  more 
time  upon  it.  As  it  is  I can  best  call  your  attention  to  the  more  imijortant 
osteopathic  points  in  relation  to  the  lungs  by  taking  up  certain  of  the  troubles 
which  affect  the  lung.  As  for  instance  in  asthma  you  may  have  trouble  anj’- 
where  along  the  back  from  the  second  to  the  seventh  ribs,  especially  on  the 
light  side.  It  is  said  that  the  sixth  rib  upon  either  side  may  be  displaced 
and  cause  this  trouble,  or  if  there  is  any  iiain  uxion  taking  a deep  breath 
probably  the  fifth  rib  is  interferred  with.  There  also  may  be  an  interfer- 
ence with  the  phrenic  and  imeumogastric  nerves  in  the  neck,  some  stoppage 
of  the  nerve  force  in  those  nerves  will  cause  asthma.  In  case  of  bronchitis  it 
is  said  the  first,  second  and  third  ribs  are  at  fault,  esxjecially  in  case  of  the 
first,  or  the  clavicle  may  be  displaced  downward,  or  either  of  the  nerves  I 
have  mentioned  in  the  neck  may  be  impinged  uijon.  In  congested  lungs  you 
will  find  the  best  method  is  to  work  along  the  ujiiier  dorsal  region,  raising  all 
the  ribs.  I have  at  that  iioint  very  quickly  relieved  the  congestion  in  the 
lungs,  simply  raising  all  the  upper  ribs;  working  between  the  shoulders. 

Hay-fever  is  usually  found  in  lesions  from  the  third  cervical  down  to  the 
fifth  dorsal;  you  may  have  trouble  either  in  the  neck  or  of  the  ux^per  ribs,  or 
your  clavicle  may  be  disx^laced,  or  those  nerves  I have  mentioned  may  be  im- 
Xtiuged  upon.  Of  course  in  working  uxton  any  of  these  troubles  where  there 
is  xtrobability  of  complication  with  general  troubles  you  must  take  that  into 
considei’ation.  In  relation  to  the  lungs  Dr.  Still  has  been  sx)eaking  recently 
of  the  formation  of  gases  upon  the  lungs,  and  that  in  fever  the  gases  are 
formed  but  are  not  transformed  into  xtersxtiration,  and  therefore  the  natural 
cooling  process  does  not  go  on  and  jmu  have  fever  resulting.  In  fever  his 
work  is  largely  ux^on  the  lungs,  he  says,  to  stimalate  them  to  action  to  cause 
the  proper  combination  of  gases  and  the  resulting  perspiration,  lu  the  same 
way  he  explained  the  other  uight  the  cause  of  the  abnormal  amount  of  secre- 
tion of  sweat  in  cases  of  cholera. 

As  to  how  to  raise  the  ribs,  I brought  out  the  points  of  examination  for 
the  ribs  the  last  time.  Dr.  Charlie  Still  has  the  patient  take  a deext  breath  and 
then  by  placing  the  fingers  of  one  hand  upon  the  spinal  end  of  the  rib  and  of 
the  other  on  the  sternal  end  of  the  rib,  he  xmshes  the  rib  either  up  or  down. 
That  is  one  method  which  he  uses.  Dr.  McConnell  frequently  works  with  his 
knee  in  the  back,  as  do  also  the  other  operators,  and  in  that  case  the  idea  is  to 
get  the  xtoint  of  the  knee  at  the  angle  of  the  rib  which  is  displaced,  and  then 
you  cau  have  one  hand  free  to  reach  over  the  shoulder  of  the  patient  and  get  at 
the  sternal  end  of  the  rib.  while  with  the  other  hand  you  bring  the  arm  up. 
thus  tensing  the  pectoral  muscles  and  the  latissimns  dorsi.  which  are  attached 
to  the  ribs ; drawing  the  arm  toward  the  head,  back  and  around  in  such  a wav 
as  to  draw  the  ribs  up.  When  you  have  gotten  them  up  to  their  highest  point, 
then  relax  the  arm  and  let  it  drop,  still  holding  the  knee  and  the  hand  agains 


142 


the  ends  of  the  rib.  Dr.  McConnell  also  sometimes  works  by  getting  the  knee 
against  the  back  and  by  putting  both  hands  against  the  front  part  of  the  rib, 
especially  when  you  want  to  raise  the  front  part.  It  does  not  make  very  much 
difference,  anyway  you  can  get  tension  ot  the  pectoral  muscles  and  the  latissi- 
mus  dorsi,  getting  a leverage  on  the  ribs,  and  having  a fixed  point  against  the 
ribs  behind ; no  matter  how  you  do  that  you  will  be  able  to  move  the  rib. 
There  is  another  way  which  is  frequently  used,  and  that  is,  the  patient  being 
upon  the  table  upon  his  side,  you  can  get  the  knee  in  the  back  in  the  same  way, 
you  can  get  one  band  upon  the  arm  of  the  patient,  the  other  upon  the  anterior 
end  of  the  rib  and  draw  the  arm  up  and  back  in  the  same  way ; thus  you  can 
raise  any  one  rib  or  all  of  the  ribs.  Also,  as  I showed  you  the  other  day  in  treat- 
ment of  the  liver,  you  can  reach  across  and  beneath  the  patient,  getting  your 
fingers  against  the  angles  of  the  ribs  and  using  the  tension  of  the  pectoral  mus- 
cles in  the  same  way  to  draw  the  ribs  up.  You  will  find  all  of  those  methods 
quite  simple,  and  the  reason,  perhaps,  that  there  are  so  many  different  ways  de- 
vised to  raise  the  ribs  is  the  fact  that  you  have  to  work  in  so  many  different 
positions,  sometimes  one  will  be  more  convenient,  sometimes  the  other.  If 
you  are  treating  a patient  sitting  on  the  bed,  or  on  the  table  you  wall  have  to 
adopt  the  method  that  will  be  the  most  convenient.  This  will  serve  to  raise 
the  different  ribs.  But  when  you  come  to  the  first  and  second  ribs  it  is  a 
different  matter.  These  displacements  are  nsually  upward  ow’ing  to  the 
scaleni  muscles  being  attached  to  them.  Hence  to  treat  them,  we  make  use 
of  these  muscles.  When  these  ribs  are  up,  one  good  way  is  to  bring  the  head 
of  the  patient  toward  the  side  of  the  rib  affected,  then  pressing  the  fingers 
down  about  the  middle  of  the  clavicle,  in  that  way  you  come  to  the  first  rib. 
You  can  get  firm  pressure  there  and  can  bring  tension  upon  it  by  pushing  the 
head  in  the  opposite  direction,  thus  stretching  the  scaleni  muscles,  which  are 
on  a strain  and  which  are  holding  the  rib  up.  Thus  we  get  those  muscles 
stretched  and  by  working  the  head  around  and  bringing  pressure  still  upon 
the  first  rib,  you  can  press  it  downward.  That  applies  to  both  the  first  and 
second  ribs.  Of  course  also  in  case  of  the  second  rib  you  can  get  the  pres- 
sure against  the  angle  behind  and  raise  it  by  working  in  the  back,  draw'ing 
up  with  the  pectoral  muscles  as  before  shown. 

Dr.  Harry  Still  frequently  works  as  follows  upon  the  upper  ribs;  in  this 
way  you  can  get  your  hands  upon  the  first  two  ribs.  He  puts  one  hand  be- 
neath the  angle  of  the  rib  and  with  the  other  he  grasps  the  elbow  of  the  pa- 
tient and  presses  the  arm  down  across  the  chest,  tlius  springing  the  ribs  out 
and  up,  and  can  get  quite  a leverage  in  that  way.  This  is  very  good  for 
these  upper  ribs.  In  case  of  overlapping  or  twisting  of  the  ribs  the  same  mo- 
tions that  I have  already  shown  you  for  raising  or  lowering  the  ribs  will  ap- 
ply. In  case  you  wish  to  treat  the  cartilages  alone,  which  you  must  not  omit 
in  your  examination,  it  is  well  to  work  with  the  fingers  against  the  cartilages 


143 


in  front,  drawing  the  arm  up  about  the  level  of  the  shoulder  and  pushing  it 
backward,  you  thus  raise  the  ribs  and  free  the  cartilages,  and  you  can  work 
any  twist  out  of  them  in  that  way,  or  work  them  up  or  down  at  the  time.  I 
have  heard  that  method  frequently  mentioned  by  Dr.  McConnell. 

As  to  the  lower  ribs  they  may  be  up  or  down,  or  slipped  or  twisted  in 
different  ways.  One  of  the  best  methods  is  to  flex  both  knees,  then  by  get- 
ing  your  thumb  against  the  point  of  the  rib  which  is  out  you  can  bring  pres- 
sure there,  with  the  fingers  of  the  same  hand  back  of  the  angle  of  the  rib, 
tlien  by  drawing  the  legs  down  in  this  way  you  can  get  a stretching  motion 
upon  the  muscles.  In  case  the  displacement  has  been  downward  by  contrac- 
tion of  the  muscles,  you  will  hold  the  rib  up  in  that  way  and  thus  stretch  the 
]uuscles.  Or  in  case  the  rib  has  been  displaced  ujjward  you  must  work  it 
down  as  you  go  by  the  tension  of  the  muscle  in  straightening  of  the  knees, 
and  by  pressure  with  the  thumb.  Dr.  McConnell  has  the  patient  take  a deep 
breath,  he  then  in  case  the  rib  is  displaced  downward  exaggerates  it  by  press- 
ing it  still  further  downward  at  the  free  end  and  upward  at  the  spinal  end, 
and  then  when  the  patient  lets  the  breath  go  he  will  simply  work  the  part 
up;  he  thus  springs  the  part,  gets  a fulcrum  by  having  the  lungs  inflated  and 
allows  the  rib  to  take  its  natural  position.  You  cannot  always  set  a rib  at 
the  first  motion.  It  will  sometimes  take  considerable  attention  and  consider- 
able length  of  treatment  to  affect  your  object.  There  is  one  more  method 
which  I saw  Dr.  Charlie  Still  use  the  other  day  for  raising  the  floating  ribs, 
or  any  of  the  other  ribs.  This  is  what  you  would  call  a quarter  turn.  He 
gets  his  ai'in  under  the  legs  of  the  patient  and  brings  him  around  until  he  is  a 
quarter  turned  off  of  the  table,  then  he  swings  the  patient  downward,  upward 
and  back;  meanwhile  he  has  kept  his  fingers  against  the  angles  of  the  ribs, 
and  thus  pressure  of  the  hand  worked  them  back  into  place. 

Q.  Demonstrate  to  us  the  method  of  giving  immediate  relief  in  severe 
cases  of  asthma. 

A.  Any  of  the  methods  that  I showed  you  of  raising  these  particular  ribs 
on  the  right  side. 

Q.  In  case  of  the  eleventh  or  twelfth  rib  being  pressed  right  into  the 
liver  would  the  motion  you  gave  us  bring  it  out? 

A.  Yes  sir,  by  relaxing  the  unnatural  tension  no  matter  which  way  the 
parts  are.  These  motions  were  given  to  either  raise  or  lower  the  ribs.  In  the 
first  place  the  motion  of  extending  the  limbs  will,  by  the  tension  brought  upon 
the  quadrates  lumborum,  draw  the  limb  down.  You  also,  of  course,  push  un 
der  with  your  thumb,  and  get  it  against  the  point  of  the  riband  work  it  out- 
ward as  you  go. 

Q.  If  one  lung  were  badly  diseased  would  it  affect  the  pulse  on  that  side? 

A.  Not  particularly  on  that  side,  it  would  probably  affect  the  pulse  iu 
general,  probably  make  it  weaker.- 


144 


LECTURE  XXII. 

At  the  last  lecture  I considered  the  heart  and  lungs,  taking  up  first  some 
nerve  centers  for  the  heart  and  lungs,  showing  that  the  theory  of  our  work 
was,  first,  that  we  work  along  the  splanchnics,  getting  a general  equalization  of 
the  circulation,  general  effect  upon  the  heart  and  lungs,  and  further  that  we 
espcially  work  in  the  upper  dorsal  region  for  this  effect.  I also  showed  you 
the  relation  between  intercostal  and  inframammary  pains — pains  coming  from  the 
6th,  7th  and  8th  cutaneous  nerves  referred  back  to  the  4th,  5th  and  6th  inter- 
costal nerves,  these  connecting  with  the  plexus  about  the  aorta,  and  also  in 
that  way  with  the  heart ; also  that  in  the  same  way  a connection  could  be 
traced  from  the  viscera  to  these  spinal  nerves,  especially  the  4th,  5th  and  6th ; 
aud  explained  the  visceral  pains  referred  to  the  surface  of  the  body  about  the 
shoulders  and  between  the  scapula?.  Then  I mentioned  certain  accelerator 
fibres  for  the  heart  and  luugs,  and  took  up  the  examination  of  the  heart  and 
lungs,  but  had  not  time  to  go  into  the  treatment  of  the  heart  and  lungs.  I also 
showed  you  the  different  methods  of  raising  the  ribs.  To-day,  in  the  latter 
part  of  my  lecture  I wish  to  consider  the  general  treatment  of  the  heart  and 
lungs. 

Having  previously  taken  up  the  spine,  head,  its  parts,  aud  the  thorax,  we 
have  now  come  to  the  abdonmen,  which  I wish  to  consider  to-day.  First, 
however,  some  general  points  concerning  the  lymphatics.  Occasionally  the 
question  arises  in  an  Osteopath’s  mind,  what  is  his  duty  in  referece  to  the  lym- 
phatics. What  can  he  do  with  them"?  Since  they  are  important  in  the  nutri- 
tion of  th?  body,  how  can  he  gain  control  of  them?  Of  course,  since  they 
have  to  do  with  nutrition,  they  are  affected  by  general  conditions  of  the  body. 
Anything  which  affects  the  general  nutrition  of  the  body  will  affect  the  lym- 
phatics, and  vice  versa.  You  find  glands  along  the  lymphatics,  conglobate 
glands,  as  they  are  called,  especially  in  the  neck,  although  every  part  of  the 
body  is  supplied  with  them.  I have  mentioned  the  fact  that  the  lymphatics  are 
scavengers,  and  that  if  you  note  any  enlargement  in  the  neck,  it  shows  some 
trouble  in  the  head.  I have  one  case  particularly  in  mind,  a case  of  measles 
followed  by  serious  trouble  of  the  eyes,  where  these  glands  were  enlarged,  and 
had  been  so  for  quite  a while.  Another  case  of  measles  with  whooping  cough 
had  been  followed  by  enlargement  of  the  glands.  Another  case  I noted  where 
an  operation  had  been  performed  near  the  knee  for  abscess,  it  was  on  a cadaver 
that  I saw  it,  the  femoral  glands  at  the  groin  were  still  enlarged,  that  being  the 
set  of  glands  in  the  course  of  the  lymphatics  which  drained  the  lymph  from  the 
limb.  Of  course  in  tonsilitis,  or  septic  processes,  these  glands  are  affected.  It 
is  well  that  it  is  so,  for  they  prevent  the  passage  into  the  blood  of  this  septic 
matter,  which  would,  of  course,  result  in  blood  poisoning.  In  such  cases  I 
have  called  to  your  mind  that  you  must  not  treat  directly  over  the  gland,  but 
indirectly,  to  remove  the  original  cause. 


145 


As  to  the  direct  treatment  that  we  get  upon  the  lymphatics,  you  often  find 
that  the  clavicle  is  down,  and  in  such  <iase  it  may  stop  up  the  opening  of  the 
thoracic  duct  into  the  subclavian  vein,  so  occassionally  we  have  to  look  to  see 
whether  or  not  the  clavicle  is  lowered.  The  first  rib  may  cause  the  same 
trouble  by  being  raised.  A tightening  of  the  tissues  in  these  parts  may  cause 
a stoppage  of  the  thoracic  duct  or  of  the  I’ight  lymphatic  duct.  Little  is  known 
concerning  the  innervation  of  the  lymphatic  system.  It  is  known  that  the 
lymphatic  vessels  are  supplied  in  their  middle  and  inner  coats  with  involuntary 
muscular  fibres.  The  physiologists  tell  us  that  the  How  is  influenced  in  three 
main  ways : First,  the  general  muscular  exercise  of  the  body,  aided  b}’  the  ac- 
tion of  the  valves  in  the  lymphatics  which  prevent  a backward  setting  of  the 
lymph,  helps  forward  the  flow.  Another  method  by  which  its  flow  is  aided  is 
the  movements  of  the  thorax  in  inspiration  and  expiration;  the  pumping  mo- 
tion of  the  chest.  The  third  way  is  the  vis  a tergo,  the  force  of  the  cireula- 
behind — the  continual  expulsion  of  the  lymph  from  the  blood  vessels  forcing 
the  onward  flow  of  the  lymph  in  the  Ij^mphatic  system,  Of  cuurse  the  flow  is 
more  restricted  by  the  presence  of  the  glands  in  the  course  of  the  lymphatics. 
However,  it  is  stated  that  there  are  certain  nerves  controlling  all  these  lymphat- 
ic's. That  there  are  fibr-es  in  the  upper  cervical  region  which  control  the  cali- 
bre of  the  duct.  That  probably  the  thoracic  duct  itself,  and  the  general  lym- 
phatic system  are  under  the  control  of  the  sympathetic  system.  And  the  re- 
ceptaculum  chyli  is  probably  under  control  of  the  splanchnies  directly.  There 
is  a point  at  the  fourth  dorsal  called  by  the  “Old  Doctor”  the  center  for  nu- 
trition. He  works  there  in  cases  of  obesity,  as  well  as  in  the  upper  cervical 
region.  In  cases  of  obesity  also  there  is  frequentl.y  an  enlarged  cushion,  you 
might  call  it,  of  flesh  in  the  upper  dorsal  region  ; you  will  find  that  in  almost 
every  case  where  a person  is  extremely  fleshh’.  It  is  said  that  the  enlargement 
affects  not  onyy  the  general  condition  of  the  body  in  that  way,  but  the  heart 
and  the  eyes  as  well,  and  I have  frequently  seen  it  so.  Mrs.  Patterson,  in  de- 
scribing the  treatment  for  obesity,  said  that  we  treat  at  this  region  to  reduce 
that  cushion  of  flesh;  work  also  at  the  4th  dorsal  and  in  the  upper  cervical  re- 
gion, working  along  the  transverse  processes,  alternately  stimulating  and  in- 
hibiting nerve  force,  and  thus  getting  an  effect  upon  the  thorcic  duct.  So  that 
the  Osteopath  sometimes  works  direetlj’  to  remove  some  obstruction,  as  for 
instance,  at  the  clavicle  or  the  first  rib,  and  then  the  effet  that  he  may  get 
through  its  possible  nerve  supply,  added  also  to  the  effect  that  he  gets  by  gen- 
eral manipulation  of  the  body  and  the  stirnultiou  of  the  lungs  and  the  working 
of  the  parts,  which  would  all  aid  the  onward  flow.  And  where  the  trouble 
with  the  lymphatic  system  is  due  to  the  genei-al  condition  of  nutrition,  there 
he  would  get  his  indirect  effect  by  working  upon  the  lungs,  heart,  bowels,  liver, 
kidneys,  and  all  the  excretory  and  nutritional  organs. 

As  to  the  abdomen,  we  know  that  it  is  important  to  us  from  the  fact  that 


146 


its  contents  are  so  often  complicated  with  disease.  It  contains  important  or- 
gans of  nutrition.  These  organs  are  directly  aceessable  to  pressure  from  the 
outside,  hence  it  is  the  OsteopatJi  works  so  frequently  upon  the  abdomen- 
Here  I believe,  too,  we  are  not  in  danger  of  becoming  masseurs — simply  to 
kneading  the  abdomen,  as  you  might  say,  which  of  course  is  not  the  principle 
at  all,  although  we  work  upon  the  abdomen  and  frequently  knead  it.  The  prin- 
'’iple  is  to  work  for  the  blood  and  nerve  control,  as  in  other  cases  : occasionally 
we  do  use  a kneading  to  force  onward  the  fecal  matter  in  the  large  intestine. 

The  abdomen  is  important,  then,  since  it  is  related  to  the  general  health, 
and  is  readil}’  reached  by  us.  The  fact,  also,  that  we  reach  it  through  the 
splanchnic  nerves  along  the  spine,  of  which  I have  already  spoken,  and  through 
the  solar  plexus  in  front,  which  we  can  get  by  deep  pressure  makes  it  an  impor- 
tant part  to  us.  When  we  work  upon  these  nervous  connections  we  have  influ- 
enced the  various  viscera,  since  they  are  all  connected. 

II.  Some  nerve  centers  and  nerve  connections  of  the  abdominal  contents. 
The  general  facts  in  this  connections  have  already  been  considered.  I have 
mentioned  the  effect  of  abdominal  tumors — the  fact  that  a tumor  pressing  upon 
the  sympathetics  may  produce  an  effect  in  distant  parts  of  the  body.  I call 
your  attention  again  to  the  familiar  splanchuics  ; you  know  where  to  reach  them  : 
nervous  influence  passes  from  them  to  the  solar  plexus,  the  solar  plexus  is  inti- 
mately connected  with  the  other  prevertebral  plexuses,  viz.,  the  hypogastric  and 
the  pelvic  plexuses,  and  these  in  turn  are  connected  with  the  secondary  plexu- 
ses— the  diaphragmatic,  the  superior  and  inferior  mesenteric,  the  renal,  the 
coeliac,  prostatic,  vesical  and  uterine,  and  all  the  secondary  plexuses.  So  it  is 
not  strange  that,  as  I stated,  there  will  hardly  an  hour  pass  in  your  practice 
that  you  will  not  work  upon  the  splanchnics  for  something  or  other.  Do  not 
fall  into  the  error  of  thinking  that  it  is  only  by  our  work  upon  the  splanchuics 
and  the  solar  plexus  that  we  reach  the  abdominal  organs.  Because,  as  you 
know,  this  chain  of  sympathetic  ganglia  extend  the  full  length  of  the  cord ; there 
are  four  lumbar  and  four  sacral  ganglia,  and  branches  from  the  lumbar  cord 
pass  to  these  plexuses  of  the  sympathetic  and  have  to  do  with  the  life  of  the 
viscera.  Sometimes  reflected  impulses  are  sent,  as  for  instance,  abdominal  tumor 
causing  hypertrophy  first,  and  then  degeneration  of  the  heart. 

However,  to  take  a slightly  different  course,  I wish  to  call  your  attention 
to  the  explanation  given  for  a frequently  observed  phenomenon,  that  is,  in 
hysteria,  frequently  a pain  is  felt  in  the  hip  or  knee,  a cramping  of  the  leg  or 
pain  on  the  inside  of  the  knee.  The  explanation  given  by  Hilton  is  as  fol- 
lows ; that  from  the  ovaries  and  uterus,  which  are  supplied  by  sympathetics, 
branches  run  back  to  tlie  sacral  sympathetic  ganglia,  thence  oranches  run  to 
connect  these  organs  and  these  nerves  with  the  great  sciatic  and  with  the  obtur- 
ator nerve,  also  with  the  sacral  plexus  of  nerves.  Now,  the  great  sciatic,  as  you 
ki  ow,  supplies  the  thigh,  or  at  least  sends  branches  to  the  hip  joint,  and  the 


M7 


obturator  also  has  articular  branches  to  the  knee  joint.  Hence,  it  is  not 
strange  that  uterine  irritation  will  produce  a pain  along  the  paths  of  these  nerves 
and  may  affect  the  hip  or  knee-joint  or  both,  or  the  inner  side  of  the  knee. 
The  same  thing  is  noted  in  intestinal  disease,  where  the  irritation  in  the  lower 
bowel  may  send  the  same  kind  of  an  irritation  over  the  same  nervous  connec- 
tions and  on  down  the  leg,  and  you  have  a sciatica  caused  by  trouble  in  the 
bowel.  Cases  have  been  noted  frequently  in  our  practice,  where  a pregnant 
uterus  or  the  pressure  of  a large  amount  of  focal  matter  will  cause  a cramping 
of  the  leg ; a twisted  ilium  would  have  the  same  effect.  These  nerve  connec- 
tions are  all  extremely  interesting  to  us.  However,  we  should  not  lose  sight  of 
the  main  points  in  our  work  upon  nerve  connections ; when  we  are  considering 
nerve  connections  we  are  apt  to  become  too  theoretical.  If  we  can  trace  the 
pain  up  the  leg  to  the  sacral  plexus  and  find  a twisted  ilium,  we  have  done  the 
work  which  is  almost  peculiar  to  the  Osteopath.  And  so  it  is  that  we  must  look 
for  the  original  cause,  whatever  it  may  be.  And  remember,  please  that  it  is 
very  frequently  that  the  Osteopath  finds  a displacement  of  parts,  and  the  suc- 
cesses of  our  practice  have  been  Iragely  because  we  understood  where  to  look 
for  and  how  to  adjust  misplaced  parts. 

In  the  first  few  lectures  I gave  you  certain  centers  which  had  to  do  with 
the  viscera,  for  instance,  the  second  lumbar,  being  the  center  for  partuition, 
defecation  and  micturition.  But  there  are  other  nerve  fibers  supplying  these 
parts  which  1 wish  to  call  to  your  attention.  I noted  the  fact  that  the  “Old 
Doctor”  calls  the  nutrition  center  in  general  from  the  sixth  dorsal  down,  and 
so  you  will  see  that  it  has  to  do  with  the  visceral  life,  and  hence  with  the  nu- 
trition of  the  body  very  largely.  Quain,  in  speaking  of  the  lumbar  portion  of 
the  sympathetics,  says  that  spinal  fibers  decend  in  the  cord  from  the  lower  dor- 
sal region,  and  that  fibers  also  pass  from  the  first  one  or  two  lumbar  nerves  to 
the  plexuses  of  the  sympathetics,  and  that  they  carry  vaso-constrictor  and 
secretory  fibers  to  the  lower  limbs.  These  have  been  demonstrated  more 
particularly  in  animals,  but  there  is  not  much  doubt  but  that  they  exist  in  man  ; 
also  vaso-constrictor  fibers  to  the  abdominal  vessels  are  found  in  these  nerves : 
and  motor  fibers  to  the  circular,  and  inhibitory  fibers  to  the  longitudinal  mus- 
cles of  the  rectum.  From  the  lumbar  nerves  wm  get,  first,  motor  fibers  to  the 
bladder,  they  pass  down  to  the  hypogastric  plexus  on  the  pelvic  plexus  and 
are  then  distributed  to  the  bladder.  They  supply  the  circular  muscles,  includ- 
ing the  spchincter  of  the  bladder,  and  probably  also  some  inhibitory  fibers  to 
the  longitubinal  fibers  of  the  bladder.  In  the  next  place,  we  get  motor  fibers  to 
the  uterus,  which  follow  the  same  course  as  the  motor  fibers  to  the  bladder.  It 
is  a fact  that^there  are  no  spinal  nerves  from  the  sacral  region  running  to  the  gan- 
glia of  the  sympathetic.  The  spinal  fibers  which  run  to  the  sympathetic  ganglia 
in  this  region  comes  from  the  lumbar  cord  or  from  the  lumbar  nerves,  and  it  is 
through  the  spinal  branches  of  the  sacral  nerves  that  we  get  the  effect  that  we 


148 


do  by  our  Osteopathic  work  m the  sacral  region.  Hence,  the  importance  ot  all 
the  work  the  Osteopath  does  upon  this  region  for  the  pelvic  viscera.  Freciuently 
you  work  along  the  lumbar  region  to  get  an  effect  upon  the  organs  contained  in 
the  pelvis,  and  it  is  on  account  of  the  sympathetic  connection  here  rather  than 
with  the  sacral  cord,  that  we  work  here.  However,  we  work  also  down  lower, 
but  where  we  work  in  the  sacral  region  we  get  an  effect  upon  spinal  nerves. 
The  forth  sacral  nerve,  spinal,  having  branches  from  the  second  and  third  and 
sending  branches  to  the  fifth,  is  called  by  Gaskell  one  of  the  pelvic  splanch- 
nics,  as  it  has  visceral  branches.  Having  connection  with  these  upper  sacral 
nerves  it  runs  out  to  form  a plexus  with  the  sympathetics,  and  goes  to  the  blad- 
der and  other  pelvic  viscera.  And  we  frequently  work  over  the  sacral  region  to 
release  tension  there,  set  the  coccyx,  or  set  a slip  in  the  innominate,  or  remove 
anything  which  may  affect  nerve  force  there.  From  these  visceral  branches  of 
the  sacral  nerves  we  get  the  following:  First,  motor  fibers  to  the  longitudinal 

and  inhibitory  fibers  to  the  circular  muscles  of  the  rectum ; second,  motor  fibers 
to  the  bladder,  probably  chiefly  to  the  longitudinal  muscles.  Third,  motor 
fibers  to  the  uterus;  fourth,  secretory  fibers  to  the  prostate  gland.  So  here  we 
have  a rather  anomalous  condition  of  working  directly  upon  spinal  nerves  to  get 
a direct  effect  upon  the  viscera.  You  will  find  that  from  the  sacral  fibers, 
through  the  spinal  nerves,  we  get  certain  fibers  to  the  bladder  and  rectum,  which 
are  contrary  in  their  action  to  the  fibers  to  the  bladder  and  rectum  derived  from 
the  lower  lumbar  region,  for  instance,  the  fibers  to  the  longitudinal  muscles  of 
the  bladder  are  motor,  while  those  to  the  circular  muscles  of  the  bladder  are 
inhibitory  in  the  case  of  the  sacral  nerves.  In  case  of  the  lumbar,  they  are  just 
the  opposite — inhibitory  to  the  longitudinal  muscles  and  motor  to  the  circular 
muscles  of  the  bladder.  This  applies  also  to  those  to  the  rectum,  so  that  you 
have  for  the  bladder  and  rectum  in  one  case  motor  fibers,  and  in  the  other  ease 
inhibitory  fibers,  and  thus  you  have  it  under  your  control. 

The  Osteopathic  centers  for  these  parts  I have  already  given  you.  You 
remember  that  we  work  there  upon  the  5th  sacral  for  the  spchincter  ani,  upon 
the  4th  to  relax  the  vagina,  and  upon  the  2d  and  3d  for  the  spchincter  of  the 
bladder.  In  passing  I might  also  call  your  attention  to  the  importance  of  the 
fifth  lumbar  as  a center.  Important,  in  the  first  place,  because  we  so  very  fre- 
cpiently  get  a displacement  there,  it  being  the  point  of  weakness,  the  junction 
of  the  spinal  column  with  the  pelvis;  and  important,  in  the  next  place,  because 
it  is  a center  through  which  we  work  to  reach  the  hypogastric  plexus. 

HI.  Landmarks  for  the  Abdomen: — There  are  certain  points  about  the 
abdomen  which  may  be  more  or  less  familiar  to  you,  which  I wish  to  bring  up 
for  the  sake  of  refreshing  your  memory  before  we  proceed  further.  These  are 
according  to  Holden  as  before.  The  Linea  Alba,  as  you  know,  extends  from 
the  apex  of  the  ensiform  cartilage  to  the  symphysis  of  the  pubes,  and  is  the 
thinnest  part  of  the  abdominal  wall.  The  lina  semilunaris  extends  from  a point 


149 


at  the  level  of  the  anterior  end  of  the  seventh  rib  down  to  the  spine  of  the 
pubes,  bulging  outward;  the  parts  between  them  are  attached  to  the  linea  alba 
and  to  the  semilunaris  and  are  sometimes  filled  with  some  extravasation  of  pus 
or  fluid.  The  linea  transversae  are  usually  all  above  the  umbilicus,  the  lower 
one  being  about  on  a level  with  the  umbilicus.  These  lines  on  statuary  are 
almost  always  exaggerated,  making  the  abdomen  of  a muscular  man  look  like  a 
chess  board,  which  is  not  correct.  These  are  interesting  to  us  further  from  the 
fact  that  any  one  of  these  squares  marked  off  by  the  transversae  and  linea  alba 
may  contract,  or  any  one  of  them  may  become  fllled  with  pus,  and  simulate 
some  deep  seated  abdominal  tumor  or  other  disease. 

Marks  About  THE  Pelvis  : — In  the  erect  position  a line  drawn  between 
the  highest  points  of  the  crests  of  the  ilia  is  just  about  on  a level  with  the  prom- 
ontory of  the  sacrum.  The  umbilicus  is  sometimes  stated  to  be  the  center  of 
the  body,  but  it  is  a little  nearer  the  pubes  than  the  ensiform  cartilage.  It  is 
not  true  that  if  a man  should  lie  down  on  his  back  with  his  arm  outstretched, 
a circle  drawn  with  the  umbilicus  as  its  center,  would  just  include  the  extrem- 
ities, because  this  center  varies  with  age.  It  will  be  just  above  the  umbilicus 
at  birth ; at  five  years  of  age  it  is  just  at  the  umbilicus ; and  at  thirty  it  is  just 
below  the  pubes  in  man  and  just  above  in  woman.  Of  course  it  depends  also 
on  the  length  of  the  legs. 

The  bifurcation  of  the  aorta  is  just  about  the  level  of  the  promontor}-  of 
the  sacrum,  or  you  might  say,  level  with  the  highest  point  of  the  crests  of  the 
ilia.  The  level  of  the  umbillicus  referred  to  the  spine  is  about  that  of  the  third 
dorsal  vertebra.  It  is  said  that,  taking  a point  one  inch  below  the  umbilicus 
and  slightly  to  the  left,  compression  may  be  made  upon  the  aorta.  This  point 
is  taken  because  above  the  umbilicus  there  are  structures  which  might  be  in- 
jured by  deep  pressure.  By  feeling  here  you  can  get  the  pulsation  of  the  aorta. 
Cases  are  on  record  where  the  aorta  has  been  compressed  here,  under  chloro- 
form, for  a time  sufficient  to  cure  aneurism  of  the  abdominal  aorta.  The 
umbilicus,  as  you  know,  is  sometimes  pervious,  being  the  remains  of  the  foetal 
artery  it  sometimes  does  not  close.  It  is  deeper  and  wider  in  women  than  in 
men.  As  it  is  sometimes  pervious,  there  may  be  a hernia  here,  or  escape  of 
pus,  or  of  ovarian  fluid,  or  of  entozoa.  The  umbilicus  is  also  a good  fixed 
point  from  which  measures  are  taken  in  case  of  diseases  where  it  is  necessary  to 
compare  parts  of  the  body.  Measurements  are  taken  to  the  ensiform  cartilage, 
to  the  anterior  superior  spines  of  the  ilia,  or  to  the  symphysis.  It  is  frequenly 
useful  in  fracture  to  measure  to  the  anterior  superior  spines  to  see  how  much 
the  parts  are  displaced.  In  the  median  line  behind  the  linea  alba  as  we  go 
we  have  first,  the  liver  just  below  the  ensiform  cartilage,  and  extending  about 
the  breadth  of  three  fingers.  Second,  the  stomach,  which,  when  distended, 
presses  the  transverse  colon  down  and  occupies  the  space  between  the  umbili- 
cus and  the  liver.  When  empty  it  recedes,  leaving  a slight  hollow  on  the  siir- 


150 


face,  “the  pit  of  the  stomach.”  The  transverse  colon,  when  not  displaced, 
the  middle  of  it  is  just  above  the  umbilicus.  You  will  frequently  want  to  know 
where  to  find  the  transverse  colon,  and  you  can  work  on  it  here  with  a sufficient 
degx’ee  of  certainty.  However  you  must  bear  in  mind  that  it  is  sometimes 
slipped  out  of  position,  as  in  enteroptosis.  Cases  are  on  record  where  it  was 
found  as  low  down  as  the  floor  of  the  pelvis.  Behind  and  below  the  umbilicus 
are  the  small  intestines,  when  they  are  not  displaced  by  a distended  bladder. 
The  peritoneum,  as  you  know,  is  loosely  attached  to  the  abdominal  wall;  when 
the  bladder  is  not  distended  this  peritoneum  is  in  contact  with  the  linea  alba 
all  the  way  down  to  the  pubes.  But  when  the  bladder  is  much  distended  it 
rises,  sometimes  hall  way  to  the  umbilicus,  then  the  peritoneum  is  pushed  back 
by  the  bladder,  and  between  the  peritoneum  and  the  abdominal  wall  there  is  a 
space  of  as  much  as  two  inches.  A case  is  on  record  wtiere  in  the  seventeenth 
century  a blacksmith  cut  open  the  bladder  there  and  removed  a large  stone. 
Of  course  cutting  the  peritoneum  would  have  been  a serious  matter. 

When  you  wish  to  And  the  division  of  the  aorta  it  is  a safe  w’ay  to  find  a 
point  a little  to  the  left  of  the  center  of  a line  drawn  between  the  highest  points 
of  the  crests  of  the  illia.  And,  as  I said,  compression  can  be  made  at  this 
point.  A line  bulging  slightly  outward  from  this  point  to  where  you  feel  the 
pulsation  of  the  femoral  artery  will  mark  the  course  of  the  common  and  exter- 
nal iliac  arteries.  The  first  two  inches  of  the  line  belongs  to  the  common  iliac 
artery.  Of  course  these  things  vary,  the  aorta  may  be  longer  or  shoter,  the 
bifurcation  coming  above  or  below,  or  the  common  iliac  may  be  longer  or  short- 
er. There  is  one  point  in  the  examination  of  the  the  thorax  which  I failed  to 
mention,  and  that  is  what  is  called  sueeiission.  When  there  are  fluids  in  the 
body  cavities,  especially  in  the  pleura,  a quick  shake  and  then  the  application 
of  the  ear  to  the  chest  wall  will  give  you  a splashing  sound,  and  that  is  called 
succussion. 

Also  the  Treatment  oe  Mammae  : — You  will  find  in  your  practice  that 
the  mammae  are  swollen,  inflamed  and  perhaps  caked,  or  something  of  that 
kind  and  especially  at  the  menstrual  period.  In  such  eases  it  is  a very  good 
plan  to  free  the  circulation  by  spreading  the  upper  ribs  both  in  front  and  be- 
hind. Raise  them  well  and  raise  the  clavicle,  for  there  may  be  obstruction  to 
the  internal  mammary  artery,  especially  at  the  second  interspace,  where  the  ar- 
tery perforates  and  runs  to  the  breast,  you  will  have  good  success  in  treating 
such  cases. 

General  Treatment  for  the  Heart  and  Lungs: — As  I have  said,  this 
is  just  the  indication  of  the  general  treatment.  Dr.  Harry  Still,  with  whom 
we  are  all  acquainted,  said  in  an  article  in  the  last  Journal  that  you  cannot  give  a 
a receipt  for  each  particular  treatment  and  it  is  foolish  to  try  to  do  so.  If  you 
write  a receipt  and  try  to  follow  those  directions  for  any  one'case  you  are  liable 
to  get  into  trouble  because  cases  var}L  As  he  says,  there  are  just  as  many 


151 


nervous  systems  as  there  are  human  faces,  and  just  as  many  kinds  of  parah"- 
sis  as  there  are  nervous  systems.  Thus  it  is  that  I can  only  give  you  the  gen- 
eral treatment  for  these  conditons.  In  treatment  of  the  lungs,  I have  already 
shown  you  how  to  exanine  the  lungs.  Your  idea  is  to  work  upon  the  upper 
dorsal  region,  you  know  the  center  is  from  the  2d  to  the  7th.  However,  I 
might  say  in  general  concerning  the  heart  and  lungs,  that  they  are  very  closely 
related.  When  you  have  trouble  with  one  you  frequently  have  trouble  with 
the  other,  and  they  are  so  closely  related  to  the  general  health,  that  if  you  find 
trouble  in  one  place  jmu  had  better  look  also  in  the  other.  In  treatment  of  the 
lungs,  one  of  the  chief  things  to  do  is  to  raise  the  upper  ribs,  get  your  fingers 
on  the  angles  of  the  upper  ribs  and  work  along,  pushing  the  shoulder  down 
and  back.  Or  you  can  set  your  patient  upon  a chair  and  place  your  knee  in  the 
back,  or  your  thumb,  in  the  same  way.  I have  relieved  congestion  of  the 
lungs  very  readily  m that  way. 

Also  in  treating  the  lungs  it  is  a good  idea  to  get  the  thumb  in  between 
the  clavicle  and  the  first  rib,  push  the  arm  across  the  chest  and  back  over  the 
face.  That  of  course  separated  the  clavicle  and  the  first  rib.  I have  noticed 
Dr.  Harry  Still  use  that  method  frequently,  and  the  idea  there,  is  to  spread 
these  parts,  give  the  blood  vessels  free  play — the  subclavian,  and  also  we  get 
an  effect  upon  the  phrenic  and  the  pneumogastric  nerves  which  cross  the  first 
rib  in  front  of  the  scalenus  anticus.  It  is  also  important  in  working  upon  the 
lungs  to  pay  attention  to  the  condition  of  the  pneumogastric  and  of  the  sym- 
pathetics.  Hence  it  is  that  we  work  in  the  superior  cervical  region  and  also 
upon  the  middle  and  inferior  cervical  ganglia  of  the  sympathetics.  I have 
already  shown  you  how  to  treat  them.  Yow,  your  irritation  to  the  vagus 
may  of  course  be  sufficient  to  produce  results  in  the  lungs.  It  has  to  do  with 
the  caliber  of  the  bronchial  tubes;  it  gives  them  motor,  dilator  and  constrictor 
fibers,  so  that  if  it  is  irritated  it  may  cause  contraction  and  give  you  a case  of 
asthma,  or  something  of  that  kind.  The  irritation  may  be  in  the  stomach  or 
in  the  throat,  or  anywhere  where  it  may  irritate  the  pneumogastric  nerve.  If 
the  superior  laryngeal  branch  is  irritated  it  may  result  in  catarrhal  pneumonia. 
So  you  must  look  carefully  to  the  nerves  and  treat  them  in  the  neck  at  the 
points  I have  indicated.  The  third,  fourth  and  fifth  cervical  are  particularly 
noted  because  any  displacement  here  is  liable  to  affect  the  sympathetics, 
which  has  to  do  with  the  involuntary  movement  of  the  lungs.  Then  the  first 
and  second  ribs  and  the  fifth  rib  are  particularly  noted,  but  all  the  ribs  from 
the  second  to  the  seventh  are  included,  and  all  the  upper  jjart  of  the  spine. 

I might  tell  you  also  how  to  treat  the  heart ; it  is  largely  a repetition  of 
what  has  been  said  for  the  lungs,  because  the  phrenic  and  pneumogastric  also 
supply  the  heart,  and  j’ou  must  always  look  to  them.  We  frequeutly  work 
upon  the  pneumogastric  nerve  here  iii  the  neck,  holding  against  it,  thus  in- 
hibiting its  action,  to  increase  the  beat  of  the  heart,  because  we  thus  cause  the 


152 


inhibitory  fibers  of  the  pneumogastric  to  cease  functioning.  That  is  simply  an 
adjutant,  as  I have  said  before,  we  can  get  a better  effect  in  quieting  the  heart 
or  stimulating  it  by  working  in  the  region  of  the  splanchnics  and  along  the 
upper  dorsal  region,  especially  on  the  left  side.  The  motions  I have  already 
given  you — any  of  these  spreading  motions  to  spread  and  raise  the  ribs,  will 
relieve  the  heart  trouble.  Of  course,  as  I haye  said  before,  I am  giving  you 
only  the  general  treatment.  In  any  particular  ease  you  will  probably  find  some 
one  thing  the  matter,  you  might  find  the  clavicle  down  and  affecting  the  heart, 
you  might  find  the  first  and  second  ribs  up  and  affecting  the  heart,  and  you 
might  find  any  particular  rib  in  the  upper  dorsal  region  displaced  affecting  the 
heart. 

Q.  Suppose  you  were  treating  a case  and  the  patient  would  faint  on  your 
hands,  by  what  means  would  you  bring  him  to’? 

A.  A good  way  is  to  first  get  the  head  of  the  patient  as  low  as  you  can  ; 
just  let  it  hang  over  the  lower  end  of  the  table ; and  to  refer  to  Dr.  Harry 
again,  he  says  to  slap  them,  pull  their  hair  or  anything  to  get  the  blood  started 
to  the  head ; a dash  of  cold  water  to  the  face  may  be  a good  thing. 

Q.  In  ease  of  too  much  blood  to  the  head  how  would  you  go  about  treat- 
ing it  to  throw  the  blood  away  from  it? 

A.  I would  work  first  along  the  splanchnics. 

Q.  Stimulating? 

A.  Well,  yes,  that  is,  I would  loosen  all  the  muscles,  first,  in  the  back, 
and  then  I would  have  the  patient  turn  over  and  inhibit  or  press  deeply  over 
the  solar  plexus,  to  get  the-  blood  from  the  head.  You  will  have  to  find  out 
the  cause ; the  cause  may  be  an  impacted  colon  preventing  the  circulation  in 
the  lower  part  of  the  body.  Or  you  may  stimulate  the  lungs  and  get  it  started 
through  the  whole  body ; your  idea  is  to  equalize  the  blood  flow. 

Q.  In  ease  of  too  much  heart  action,  what  would  be  the  quickest  way  to 
reduce  it? 

A.  The  quickest  way  that  I have  found  is  simply  to  separate  the  upper 
ribs  and  raise  them  on  the  left  side,  and  I have  done  it  by  the  count,  I have 
lowered  it  as  much  as  twenty  beats,  and  it  stayed  that  way  until  the  next  treat- 
ment ; when  the  patient  came  back  two  or  three  days  later  the  beat  was  the 
same.  Of  course  that  is  an  exceptional  ease,  you  cannot  always  reduce  them 
that  much. 

Q.  Please  give  the  treatment  to  increase  the  heart  beat? 

A.  You  should  desensatize  the  pneumogastric,  thus  letting  the  heart  run 
a little  faster ; and  then  you  would  take  this  same  movement,  because  the  ob- 
ject when  it  is  too  slow  is  a stimulation,  and  by  raising  these  upper  ribs, 
whether  it  is  too  slow,  you  may  increase  it,  or  if  too  fast  you  can  lower  it.  I 
have  gotten  effects  either  way. 

Q.  Do  lymphatics  remain  enlarged  after  the  septic  condition  has  passed 
away  ? 


153 


A.  That  is  a very  hard  question  to  answer.  I have  seen  their  stay  en- 
larged so  very  long  that  it  looked  as  if  they  might,  hut  I do  not  think  they  do 
really.  They  may  stay  enlarged  a long  time,  but  it  is  possible  there  is  trouble 
there  yet,  especially  if  the  person  is  in  poor  health. 

Q.  Why  are  they  enlarged  in  one  place  and  not  in  another? 

A.  Because  certain  parts  of  the  lymphatic  system  drain  certain  parts  of 
the  body. 

Q.  The  treatment  you  have  given  would  be  good  also  for  irregular  heart 
action,  would  it  not? 

A.  There  are  so  many  things  that  would  cause  irregularity  of  the  heart. 
As  I have  said,  a stoppage  of  the  subclavian  vein  causing  a periodical  empty- 
ing of  it,  caused  by  a slipping  of  the  clavicle,  would  cause  the  heart  to  lose  a 
beat.  An  irritation  to  the  sympathetics  in  the  dorsal  region  would  cause  a 
constriction  of  these  vessels  and  thus  an  irregular  filling  of  the  heart,  causing 
it  to  lose  a beat. 

(Dr.  Harry  Still)  I will  tell  you,  doctor,  when  it  originates  from  the  stomach 
you  can  press  upon  the  pneumogastric  and  quiet  it  down.  Simple  pres- 
sure, from  two  and  a half  to  five  pounds  pressure,  for  a minute  and  a half  to 
two  minutes. 

Q.  Would  not  that  desensatizing  movement  tend  to  stimulate  the  heart? 

A.  In  what  way? 

Q.  A desensitization  of  the  pneumogastric. 

A.  Not  with  a slight  pressure. 


LECTUEE  XXIII. 

To-day  I wish  to  consider  further  the  abdomen  and  its  contents.  I have 
already  given  you  certain  centers  for  the  vaso- motor  control  of  these  jiarts, 
necessarily  so  in  considering  the  splanchnics.  But  there  is  much  more  that 
might  be  said,  so  I will  mention  some  further  fibers  which  go  to  these  parts, 
which  teach  us  how  we  can  control  them. 

First,  as  to  the  stomach.  We  know  that  we  reach  it  through  the  solar 
plexus  and  through  the  splanchnics,  also  through  the  vagi.  We  must  not 
forget  in  dealing  with  the  stomach  that  probably  Auerbach’s  and  Meissner's 
plexuses  have  to  do  with  it  as  well  as  with  the  intestines.  Eobinson  says 
that  the  gastric  and  intestinal  secretions  are  under  the  control  of  Meissner  and 
Billroth’s  plexus,  aided  by  Auerbach’s  plexus.  Further,  note  certain  state- 
ments in  Howell’s  Text  Book:  The  mesenteric  vessels  are  under  the  control 

of  the  splanchnics,  which  contain  both  vaso-dilators  and  vaso-constrictors. 
The  vaso-constrictors  for  jejunum  are  up  as  high  as  the  fifth,  and  extend  from 
there  dowm  a ways,  it  does  not  state  how  far.  Those  for  the  ileum  a little 
lower,  and  those  for  the  rectum  come  off  still  lower  along  the  splanchnic  re- 


154 


gion.  There  are  none,  however,  below  the  second  lumbar.  The  vaso-dilators 
are  present  in  the  same  nerves  in  these  regions,  and  here  is  a chance  to  bring 
in  a point  of  whether  we  inhibit  or  stimulate.  I think  we  understand  fully 
that  point,  and  I do  not  think  you  will  split  hairs  over  those  things.  How- 
ever, the  vaso-dilators  are  more  abundant  in  the  lower  three  dorsal  and  in  the 
upper  two  lumbar.  The  vaso-dilator  and  vaso-constrictor  fibers  of  the 
splanchnics,  ending  in  the  solar  and  renal  plexuses,  have  the  vaso-motor 
supply  of  the  liver.  The  splanchnics  contain  the  vaso-dilators  and  vaso-con- 
strictors  for  the  liver  probably.  It  is  said  that  there  are  vaso-dilators  also  in 
the  vagi  nerves.  However,  this  matter  is  not  settled,  and  they  are  not  per- 
fectly sure  about  the  existence  of  these  fibers.  However,  it  makes  but  little 
difference  to  the  Osteopath,  since  he  can  rule  the  flow  of  blood  through  the 
liver  in  other  ways,  as  we  shall  see  presently. 

Then,  as  to  the  kidneys,  there  are  vaso-motor  fibers  from  the  sixth  dorsal 
down  to  the  second  lumbar.  You  know  that  we  can  get,  more  easily,  per- 
haps, on  the  kidneys  than  on  any  other  organ  a vaso-motor  effect  refiexly  by 
the  application  of  cold  to  the  skin.  And  then  by  stimulating  the  sciatic 
nerves  it  has  been  found  that  one  can  get  a vaso-motor  effect  upon  the  kid- 
neys. This  seems  to  be  in  line  with  what  has  been  said  concerning  an  equilib- 
rium between  the  blood  flow  in  different  parts  of  the  body.  There  are  cer- 
tain centers  that  the  Osteopath  works  upon.  The  “Old  Doctor”  says  there 
is  a center  in  the  skin,  that  is,  a peritoneal  center,  about  one  inch  each  side 
of  the  umbilicus,  and  that  work  there  is  beneficial  both  upon  the  kidneys  and 
upon  the  intestines,  and  we  often  make  a mere  spreading  motion  there  at  the 
umbilicus,  just  press  in  deep  and  spread  apart,  not  hard,  for  work  upon  the 
renal  veins  and  arteries.  That  always  seems  to  have  a good  effect  in  treating 
the  kidneys.  Of  course  you  know  the  micturition  center  is  the  second  lum- 
bar, but  you  have  already  been  cautioned  not  to  go  too  much  according  to 
centers;  look  for  the  lesion,  which  may  be  some  place  away  from  the  center. 

As  to  the  spleen,  it  is  found  that  stimulation  of  the  peripheral  end  of  the 
splanchnics  will  cause  quite  a change  in  the  size  of  the  spleen,  that  is,  in  its 
bulk,  but  it  is  not  really  known  whether  it  is  on  account  of  vaso-motor  con- 
trol, or  because  of  an  effect  upon  those  involuntary  muscle  fibers  which  you 
saw  so  nicely  under  the  microscope — you  know  how  the  capsule  and  the 
trabeculm  of  the  spleen  are  well  supplied  with  involuntary  muscle  fibers,  and 
you  remember  how  the  oval  nuclei  of  those  fibers  are  easily  seen.  However, 
from  the  Osteopathic  point  of  view,  it  makes  little  difference  whether  he  can 
in  one  way  or  the  other  change  the  size  of  the  spleen,  so  long  as  he  does  it, 
that  is  what  he  is  after.  He  does  not  care  whether  it  is  through  muscular  or 
vaso-motor  control,  or  whether  he  can  work  upon  the  splanchnics  and  thiis 
reduce  its  size.  Should  he  do  that,  of  course  he  would  thus  change  the  flow 
of  blood  through  it.  There  is  a great  deal  not  understood  abont  the  spleen. 


155 


There  is  a very  good  Osteopatliie  j)oint,  however,  I have  often  heard  Mrs. 
Patterson  speak  of  it,  that  is,  treatment  of  the  spleen  in  connection  with 
treatment  for  gall  stones.  She  says  you  can  treat  for  gall  stones  and  remove 
them  but  they  will  form  again  unless  you  treat  the  spleen  on  the  left  side  over 
the  ninth,  tenth  and  eleventh  ribs.  And  as  far  as  I know  that  is  part  of  the 
practice.  I have  not  heard  that  statement  refuted  by  any  one.  Another  point 
as  to  the  spleen — in  treating  it  you  will  sometimes  find  it  congested;  it  is  like 
the  liver  in  that  respect,  they  are  both  liable  to  congestive  disturbances.  You 
may  by  working  dee})  in  the  left  hyj)ochondriac  region  reach  the  spleen,  but 
when  the  spleen  is  distended  with  blood  it  is  said  it  is  very  readily  ruptured; 
and  if  you  find  the  spleen  enlarged  and  tender  I would  advise  you  to  treat 
rather  over  the  back  through  the  spinal  nerve  sui^ply  than  over  the  abdomen. 
I think  I might  emijhasize  once  more  the  importance  of  the  Osteopathic  work 
upon  the  abdomen.  As  I have  already  said,  I think  here  we  are  in  more 
danger  than  anywhere  else  of  becoming  masseurs.  Indeed  I do  not  think  we 
need  to  learn  the  baker’s  trade  before  we  can  work  on  the  abdomen,  and  we 
ought  to  bear  in  mind  that  although  we  knead  there,  we  work  there  as  di- 
rectly as  in  other  parts  of  the  body  for  nerve  control  and  for  the  blood 
flow.  And  the  fact  that  we  knead  the  abdomen  occasionally  is  not  any  sign 
that  we  simply  knead  it  as  a masseur  does.  Of  course  there  are  times  when 
we  depend  upon  the  mere  mechanical  movement,  as  when  we  begin  at  the 
sigmoid  and  work  on  back  to  loosen  up  the  fecal  contents,  but  our  chief  work 
is  upon  the  nerve  supply.  I think  I have  already  mentioned  the  point  that 
by  work  upon  the  abdominal  peripheral  terminals  we  can  stimulate  or  inhibit. 
I merely  call  it  to  your  mind  again,  that  by  getting  the  peripheral  terminals 
in  the  organs  of  the  abdomen,  which  we  can  reach  by  pressure  over  the  ab- 
domen, and  by  getting  these  various  plexuses  from  the  solar  down,  we  can 
get  an  effect  upon  these  organs,  and  that  is  what  we  are  reaching  when  we 
are  working  the  abdomen.  For  instance,  we  frequently  work  along  the  whole 
length  of  the  great  intestine.  AYhat  are  we  doing?  You  will  remember  that 
Auerbach’s  and  Meissner’s  plexuses  are  found,  the  first  between  the  muscu- 
lar coats,  and  has  to  do  with  the  motions  of  the  intestines;  and  second, 
deeper,  in  the  submucous  coat,  and  has  to  do  with  the  secretions.  Xow,  we 
may  work  in  the  region  of  the  abdomen,  and  the  beginning  Osteopath,  who 
does  not  understand,  may  think  he  is  simply  kneading,  but  such  is  not  the 
fact,  we  are  reaching  terminations  of  nerves.  You  know  what  the  plexuses 
look  like,  with  their  meshes,  in  the  interuodes  of  which  are  ganglia:  they  (the 
ganglia)  are  centers  upon  which  you  may  work  directly  by  pressure  over  the 
abdomen.  Thus  it  is,  I think,  that  we  get  the  best  explanation  in  regard  to 
the  Osteopath’s  successes  in  treating  abdominal  troubles,  such  as  constipa- 
tion, diarrhea,  enteritis,  and  a whole  list  of  troubles  which  affect  man,  and 
our  success  there  is  marked.  Byron  Eobinsou  says:  “Gastro-intestinal 


156 


secretion  appears  to  be  earried  on  by  the  Meissner-Billroth  aided  by  Auer- 
bach’s plexus  of  nerves,  which  are  sympathetic  ganglia,  automatic  visceral 
ganglia.  ’ ’ As  I have  said,  since  they  are  ganglia,  they  are  centers,  and  since 
they  are  automatic,  they  are  to  a certain  extent  independent,  and  that  by 
stimulating  them,  whether  we  go  back  to  the  splanchnics  so  much  or  not, 
you  get  the  effect  as  you  have  an  independent  source  of  nerve  supply  here. 
Indeed,  Eobinson  in  making  this  statement,  is  doing  so  to  establish  his  point 
that  the  sympathetie  is  largely  independent  in  its  action.  We  must,  however, 
couple  our  work  here  with  work  in  other  places,  and  we  must  not  forget  also 
that  the  nerve  centers  chiefly  are  along  the  spine.  We  do  our  work  largely 
here  also  by  the  blood  flow.  I have  emphasized  the  nerve  control  and  the 
blood  flow.  Eobinson  says  that  the  movement  of  the  intestines  is  largely  de- 
pendent on  the  amount  of  blood  in  the  intestinal  wall.  That  is,  on  the  amount 
of  fresh  blood  which  affects  the  parenchymal  ganglia.  We  have  a certain 
number  of  ganglia  in  these  walls;  they  must  be  supplied  with  blood  if  they 
are  to  act  properly;  that  is,  with  good,  fresh  blood.  And  by  working  over 
the  splanchnics  and  by  this  manipulation  process  you  can  throw  great  quan- 
tities of  blood  to  the  abdominal  viscera,  and  thus  supply  these  ganglia  with 
an'  added  amount  of  blood,  and  that  will  also  help  to  explain  how  we  get  our 
effect  upon  the  nervous  system  there.  And  when  you  have  done  that  you 
rule  both  secretion  and  motion.  Of  course  that  has  to  do  very  closely  with 
constipation  and  diarrhea  and  those  things.  Your  peristalsis  may  be  too 
rapid,  and  thus  you  would  have  a case  of  diarrhea,  or  it  may  be  just  as  rapid, 
but,  as  Eobinson  says,  futile,  and  you  will  have  constipation.  You  have  to 
couple  with  that  work  the  ruling  of  secretions  through  Meissner’s  and  Auer- 
bach’s plexuses,  and  if  they  are  too  abundant  you  have  diarrhea;  if  deficient, 
you  would  have  constipation.  The  fact  then,  there,  as  in  other  cases,  is  that 
we  remove  lesions  and  these  secretions  attend  to  themselves,  they  become 
normal;  a change  in  the  amount  of  motion  and  a change  in  the  quantity  or 
quality  of  secretions;  so  we  work  toward  the  normal.  We  might  repeat  this 
for  every  organ  in  the  abdominal  cavity.  When  we  work  for  the  uterus,  the 
bladder,  or  in  the  intestines,  or  the  ovaries,  we  work  very  largely  through 
the  nerve  control,  as  is  evidenced  by  the  fact  that  in  case  of  those  organs  we 
work  generally  through  the  spine,  along  the  lower  part.  It  might  be  thought 
that  the  motions  we  employ  in  our  work  upon  the  liver  are  exceptions  to  this 
rule,  but  I think  not.  We  frequently  work  against  the  lower  edge  of  the 
liver,  but  we  cannot  work  much  of  its  bulk  by  our  direct  kneading  motion 
there,  and  I think  what  we  do  there  is  the  same  as  elsewhere,  we  affect  the 
nerves  as  well.  We  affect  the  hepatic  plexus  of  the  sympathetics  directly  by 
manipulation  there,  and  indirectly  through  the  solar  plexus,  also  through  the 
splanchnics,  and  the  vagi.  If  you  will  watch  Dr.  Harry  Still  you  will  see 
that  he  will  scarcely  ever  omit  to  treat  the  vagi,  when  treating  the  liver,  as  it 


157 


contains  vaso-niotor  fibers  for  this  organ.  So  our  work  in  kneading  is  largely 
work  upon  nerve  connections.  There  is  a good  ijoint  that  I would  like  to 
note  in  speaking  of  the  liver.  I have  seen  a case  in  which  there  was 
hemorrhages  from  the  lower  bowel;  whenever  the  trouble  occurred  there 
would  be  a tenderness  and  trouble  about  the  liver,  and  the  portal  circulation 
would  be  stopped.  There  is  a close  connection  between  the  portal  circulation 
and  hemorrhoidal.  Here  you  have  this  great  amount  of  blood  which  must 
pass  to  the  abdomen  and  through  these  terminal  vessels,  and  which  must  find 
its  way  back  through  the  portal  circulation  and  through  the  liver  to  be 
worked  upon  by  it.  These  hemorrhoidal  veins  connect  with  the  portal  veins; 
so  that  if  you  have  an  obstruction  in  the  liver  you  are  very  apt  to  find  trouble 
in  the  way  of  hemorrhoids,  piles,  or  something  of  that  kind.  So  remember, 
please,  that  there  is  a further  object  in  freeing  the  splanchnics,  as  a regulative 
process.  You  might  say  that  this  is  true,  but  you  might  go  farther  and  say 
that  the  liver  in  this  case  is  a ‘‘stop  cock,”  that  it  is  sometimes  turned  when 
it  should  not  be,  and  is  stopping  the  blood  and  you  have  a congestion  of 
blood  at  the  lower  bowel.  You  remember  that  the  liver  is  particularly  liable 
to  congestion,  and  if  it  is  congested  the  blood  flow  is  retarded  and  you  have 
a series  of  abdominal  troubles. 

II.  Landmarks  foe  the  Abdomen. — I began  this  last  time,  and  wish 
to  continue  them  to-day.  In  examining  a patient,  as  you  all  know,  perhaps, 
it  is  best  for  abdominal  examination  and  treatment  to  have  the  patient  flat  on 
the  back;  have  the  thighs  flexed  a little  to  relax  the  abdominal  muscles;  have 
the  head  and  neck  slightly  elevated,  as  much  as  it  is  raised  by  this  table,  this 
will  help  to  relax  the  recti  muscles.  Thus  you  have  everything  relaxed,  and 
unless  the  abdominal  wall  is  unusually  tense  through  its  own  condition,  you 
have  a good  place  to  work.  Then  in  working,  I believe  that  beginning  Os- 
teopaths “dig”  here  perhaps  as  much  as  in  any  other  place.  That  is,  they 
use  the  ends  of  their  fingers.  Not  only  Osteopaths  but  surgeons  make  the 
statement  that  that  is  very  wrong.  Holden  says  to  use  the  tips  of  the  fingers 
causes  the  parts  to  contract.  Thus  you  defeat  your  own  object.  You  should 
lay  the  fiat  of  the  hand  on  the  abdomen.  I have  seen  the  worst  digging  over 
the  abdomen,  and  it  is  wrong,  because  you  are  not  kneading  and  you  cannot 
force  any  condition  there,  and  you  had  better  not  try.  Dr.  Hildreth  always 
emphasizes  the  point  that  in  working  upon  the  abdomen  you  must  work  for 
nerve  influence;  and  that  is  especially  noted  in  D'phoid  fever,  where  you  have 
au  ulceration  in  Peyer’s  patches,  and  if  you  try  to  work  matters  along  me- 
chanically, you  are  liable  perforate  the  ulcerated  irlaces. 

The  central  tendon  of  the  diaphragm  is  about  on  a level  with  the  lower 
end  of  the  sternum,  about  the  level  of  the  junction  of  the  seventh  costal  carti- 
lage with  the  sternum.  The  right  half  of  the  diaphragm  will  rise  as  high  as 
the  fifth  rib  when  the  diaphragm  is  extended,  and  to  one  inch  below  the  level 


158 


of  tlae  nipple;  rather  higher  than  one  usually  expects  to  look  for  it.  The 
position  of  the  abdominal  contents  is  variable.  There  is  quite  a contrast, 
says  Loomis,  between  the  examination  of  the  contents  of  the  thorax  and  those 
of  the  abdomen.  In  the  first  instance  you  have  close  walls  and  contents 
which  may  vary  but  little,  especially  under  physiological  conditions.  While 
in  the  other  you  have  lose  walls,  you  have  numerous  organs,  some  of  which 
at  least,  vary  considerably  within  physiological  limits.  So  you  see  it  is  a 
different  matter  when  you  go  to  the  abdomen  to  examine  or  treat  it,  and  you 
must  constantly  guard  against  wrong  diagnosis  by  being  mistaken  which 
organ  is  at  fault.  Then,  too,  the  action  of  the  abdominal  organs  is  more  or 
less  peculiar.  Take  the  stomach,  at  different  times  it  changes  its  position 
when  it  is  distended;  so  it  is  with  the  bowels;  and  according  to  the  position 
they  assume,  the  others  are  also  displaced;  so  you  must  bear  that  in  mind. 

I wish  to  simply  call  to  your  attention  the  regions  of  the  abdomen.  You 
know  that  it  is  divided  into  three  zones — the  epigastric,  umbilical  and  hypo- 
gastric. The  ej)igastric  region  is  bounded  above  by  the  diaphragm,  below  by 
a plane  passing  from  the  anterior  tips  of  the  tenth  rib,  and  between  the  bodies 
of  the  first  and  second  lumbar  vertebrte  behind.  That  zone  is  divided  into  a 
right  and  left  hjq)oehondriac  regions,  behind  the  false  ribs,  and  the  eitigastric 
zone,  between  the  umbilical  zone  is  bounded  above  by  the  epigastric  and  below 
by  a plane  jjassed  from  the  highest  points  of  the  crests  of  the  ilia,  striking  a 
point  between  the  first  and  second  sacral  spines  behind.  And  the  lower,  or 
hypogastric  zone  is  the  one  below  the  umbilical,  and  occupies  the  region  of 
the  pelvis.  These  two  zones  are  each  divided  into  three  by  an  almost  vertical 
plane  on  each  side,  passed  from  the  prominence  at  the  tip  of  the  tenth  rib  to 
the  pubic  spine,  so  you  have  two  planes.  In  the  middle  zone  the  regions 
are  the  right  and  left  lumbar  and  the  umbilical,  and  in  the  hypogastric  zone 
the  regions  are  the  right  and  left  iliac  and  the  pubic.  The  lower  zone  is 
bounded  below  by  the  upper  edge  of  the  pubes  and  by  the  two  Pouparts’s  liga- 
ments, one  on  each  side.  It  will  not  be  necessary  to  detail  the  contents  of  these 
regions,  I will  refer  to  the  contents  as  it  becomes  necessary  later. 

As  to  the  liver,  it  is  found  mainlv  in  the  right  hypochondriac  region  and 
extends  across  into  the  central  or  epigastric  region, and  as  far  toward  the  left  as 
the  maminarv  line.  It  may  extend  down  two  or  three  inches,  and  at  this  point, 
behind  the  linea  alba  and  the  median  line  is  the  best  place  to  find  the  liver ; it 
protrudes  half  way  to  the  umbilicus,  but  you  will  not  be  able  to  find  it  until 
your  hand  is  educated.  Of  course  the  liver  may  protrude  lower  in  disease.  I 
have  seen  a liver  that  weighed  sixty  pounds  ; they  become  enormously  large  at 
times.  It  may  extend  down,  as  for  instance  in  tight  lacing,  when  it  is  not  dis- 
eased, and  you  will  have  to  judge  what  the  general  condition  is. On  the  right 
side, where  it  goes  a little  higher,  it  may  ascend  as  high  as  the  diaphram,  about 
an  inch  below  the  nipple,  and  below,  at  the  lower  edge  of  the  lung,  or  as  low  as 


159 


tbe  tenth  dorsal  spine.  The  liver,  remember,  is  a very  important  organ.  I do 
not  think  that  with  all  that  Dr.  Harry  Still  says  about  the  liver  it  is  any  to 
much  impressed  upon  our  minds,  because  it  is  extremely  important  to  us  in  our 
practice.  The  gall  bladder  you  will  find  just  beneath  the  tip  of  the  ninth  rib  on 
right  side,  but  it  is  behind  the  liver,  and  you  are  not  able  to  find  it,  and  it  is 
only  when  distended  to  a great  degree  that  it  can  be  noticed ; even  that  you  do 
not  feel  it  directl}'.  But  we  work  there  to  get  an  effect  upon  the  gall  bladder 
and  press  its  contents  out.  We  work  down  that  duct  in  a reversed  -‘S”  shape 
to  the  umbilicus,  a little  to  the  right. 

The  stomach  is  one  of  the  most  variable  organs  of  the  abdomen.  You  all 
know  how  much  it  descends  at  times  when  distended  with  gas  or  over  distended 
with  food.  At  that  time  instead  of  simply  descending,  it  turns  on  its  axis  and 
the  greater  curvature  comes  to  the  front,  because  the  greater  curvature  is  not  so 
strongly  attached  as  is  the  lesser.  When  the  stomach  becomes  thus  distended 
it  will  push  away  those  organs  ju  front,  and  even  may  occupy  all  the  space  from 
the  lower  edge  of  the  liver  or  the  tip  of  the  ensiform  down  to  the  umbilicus, 
and  in  such  a case  yon  are  likely  to  have  great  dj'spnoea  and  palpitation  of  the 
heart.  I remember  a case  in  which  about  three  hours  after  a meal,  the  gentle- 
man had  eaten  rather  hearty,  he  nad  great  distress  in  breathing,  and  his  heart 
was  palpitating,  and  he  thought  he  would  die  surely.  He  called  an  Osteopath 
for  heart  trouble,  but  the  Osteopath  worked  the  undigested  food  on  through 
the  pylorus  and  worked  the  gas  off  of  the  stomach,  and  the  man’s  heart  was 
all  right.  You  will  frequently  meet  that  sort  of  a case,  and  if  you  know 
the  probabilities  you  can  be  on  your  guard  against  it.  The  cardiac  orifice  is 
just  below  the  cartilage  of  the  seventh  rib  where  it  joins  the  sternum,  and  a 
little  to  the  left.  The  stomach  when  empty  retreats  behind  the  liver  and  lies 
flat,  there  is  no  cavity  whatever  in  it.  This  reminds  me  of  a statement  made  by 
Dr.  Eckley  frequently,  that  naturally  these  are  but  potential  cavities.  The 
oesophagus  when  not  occupied  by  the  passage  of  food  or  drink  lies  with  its  in- 
ner surface  in  contact,  it  simply  collapses  and  occupies  as  little  room  as  possi- 
ble. The  same  is  true  of  the  stomach.  The  pyloric  orifice  of  the  stomach  is 
found  on  the  right  at  the  edge  of  the  sternum  about  the  point  where  the  carti- 
lage of  the  eighth  rib  joins ; it  is  behind  the  liver  and  cannot  be  felt  unless  it  is 
enlarged  by  disease. 

The  spleen  is  on  the  left  side,  below  the  ninth,  tenth  and  eleventh  ribs, 
sounded  by  percussion  over  the  tenth  and  eleventh  ribs.  I have  already  given 
3'ou  some  precautions  concerning  it.  It  may  become  very  much  enlarged,  then 
you  can  readily  feel  its  edge,  but  unless  it  is  enlarged  you  do  not  feel  its  edge. 
However,  you  can  get  indirect  pressure  on  it  under  the  edges  of  the  left  lower 
ribs.  It  is  forced  down  sometimes  in  full  inspiration. 

The  pancreas  is  not  very  easily  felt ; it  lies  behind  the  stomach,  transversely 
and  crosses  the  aorta  and  the  spleen  at  the  level  of  about  the  second  lumbar  ver- 


160 


tebra.  I mention  its  not  because  you  will  find  it  often  ; you  can  feel  it  only 
when  the  abdomen  is  very  thin  and  the  stomach  entirely  empty ; in  some  cases 
of  thin  individuals  you  might  mistake  it  for  aneurism  of  the  abdominal  aorta, 
or  you  might  take  it  for  some  disease  of  the  transverse  colon. 

The  kidneys  also  are  not  readily  felt.  It  is  said  by  Holden  that  he  does 
not  know  that  he  has  ever  felt  the  rounded  edge  of  the  kidney,  but  he  says  it  is 
accessible  to  pressure  at  the  outer  edge  of  the  erector  spinae  muscle  between  the 
lower  ribs  and  the  crest  of  the  ilium.  It  is  accessible  to  pressure  because  you 
can  get  indirect  pressure  and  can  know  when  it  is  tender.  Of  course  it  is 
sometimes  enlarged  and  can  then  be  felt.  It  corresponds  in  position  to  the 
lower  two  dorsal  and  upper  two  lumbar  vertebrae.  A point  to  know  in  relation 
to  it  is  that  it  will  sometimes  deceive  you,  or  you  will  feel  masses  of  hardened 
fecal  matter  and  think  they  are  the  kidney,  or  vice  versa ; you  must  distinguish 
between  them. 

As  to  the  large  intestine,  you  are  familiar  with  it.  The  caecum  and  ilio- 
caecal  valve  both  lie  in  the  right  iliac  fossa,  and  in  the  right  lumbar  region  and 
over  the  right  kidney  runs  the  ascending  colon,  and  across  just  above  the  um- 
bilicus for  two  or  three  inches  you  find  the  transverse  colon  ; the  descending 
colon  and  sigmoid  flexure  are  in  the  corresponding  portions  on  the  left  side. 
You  can  reach  all  of  the  colon  except  the  splenic  and  sigmoid  flexures.  How- 
ever, these  are  sometimes  prolapsed,  sometimes  sunken,  as  Robinson  states. 
Dr.  Tull,  of  our  own  practice,  has  pointed  out  that  this  is  frequently  the  case, 
and  that  prolapsus  may  cause  constipation  by  acting  as  a mechanical  hindrance 
to  the  passage  of  fecal  matter  along  the  bowel.  You  all  know  the  relations  of 
the  bowel,  and  except  at  those  two  points  you  will  be  able  to  work  upon  the 
intestine  directly. 

As  for  the  small  intestine,  the  jejunum  lies  in  the  region  behind  the  um- 
bilicus and  is  the  part  concerned  in  umbilical  hernia,  and  it  is  because  it  seems 
to  be  so  particularly  vital  that  umbilical  hernia  is  so  often  fatal.  The  point 
eonserning  the  ileum  is  that  it  contains  Peyer’s  patches,  which  are  inflamed  and 
ulcerated  in  typhoid  fever;  they  are  in  the  lower  part  near  the  ilio-eaecal  valve, 
and  just  at  the  edge  of  the  right  iliac  fossa.  Y^ou  will  have  to  be  extremely 
careful  in  treating  inflammatory  conditions  of  the  bowels,  especially  in  typhoid 
fever  and  enteritis. 

The  bladder  is  contained  within  the  pelvis  except  when  distended.  It  may 
become  over  distended  and  rise  out  of  the  pelvis  as  high  as  the  umbilicus. 
And  as  I noted  at  the  last  meeting,  when  it  rises  it  pushes  the  peritoneum  back 
away  from  the  wall  of  the  abdomen,  and  sometimes  will  leave  a space  as  great 
as  two  inches  between  them. 

I thought  I had  better  finish  the  subject  in  this  way  to-day,  leaving  the 
practical  examination  and  treatment  of  each  one  of  these  important  organs  of 
the  abdomen  until  next  time,  and  I shall  try  to  finish  this  subject  then. 


161 


LECTURE  XXIV. 

At  the  last  lecture  I considered  the  abdomen,  taking  xirst  certain  centers 
and  nerve  connections  for  the  contents  of  the  abdomen — the  stomach,  intes- 
tines, liver,  kidneys,  spleen,  and  so  on,  calling  to  your  attention  the  fact  that 
although  we  often  work  mechanically  upon  the  abdomen,  our  chief  treatment 
there  is  nevertheless  for  the  reaching  of  blood  and  nerve  supply,  taking  es- 
liecially  the  case  of  the  liver  and  of  the  bowels  in  constipation.  I then  took 
took  ui)  certain  landmarks  for  the  abdomen.  I wish  to-day  to  carry  the  sub- 
ject further. 

I.  Examination  and  Treatment  of  the  Abdomen  and  its  Contents.  In 
this  I do  not  include  the  pelvis  and  its  contents,  as  I shall  give  a further  lec- 
ture, taking  up  the  pelvis  and  the  displacement  and  treatment  of  its  contents. 
Of  course  any  one  of  these  various  organs  becomes  complicated  with  disease, 
and  the  manner  in  which  it  is  reached  and  treated  in  the  various  diseases 
might  well  take  up  a lecture,  but  I think  it  best  to  run  over  the  abdomen  and 
its  contents,  giving  the  Osteopathic  treatment  for  each  different  organ  to-day. 
perhaps  with  the  exception  of  the  kidney,  which  I will  take  up  at  the  next 
time. 

First,  as  to  the  examination  of  the  external  parts  of  the  abdomen.  I 
called  your  attention  at  the  last  time  to  the  need  of  having  the  ixatient  raise 
his  knees,  thus  flexing  the  thighs  slightly,  also  the  fact  that  our  tables  raise 
the  head  and  chest  a little,  thus  relaxing  all  the  parts  about  the  abdomen, 
leaving  the  abdominal  walls  relaxed,  so  that  you  can  readily  examine  them 
by  touch.  You  should  also  take  care  to  see  that  the  patient  is  evenly  disposed 
on  each  side,  so  that  there  would  be  equal  tension  of  the  abdominal  walls. 
Of  course  you  see  at  once  that  it  is  necessary  to  have  the  parts  equally  dis- 
posed. We  use  the  ordinary  methods  of  examination  of  the  abdomen — in- 
spection, palpation,  mensuration,  ausculation,  succession  and  percussion. 
We  use  paliration  and  percussion  irrobably  most  frequently.  The  Osteopath 
depends  upon  touch  largely,  and  also  upon  getting  the  sound  by  percussion 
from  the  different  viscera,  so  these  two  are  the  most  important  methods  of 
examination  that  we  have.  We  should  first  inspect  the  abdomen,  this  is 
best  done  next  the  skin.  We  note  its  general  appearance;  you  will  find  in 
some  eases  enlargement  due  to  inflation  from  gases  in  the  bowels.  In  such 
cases  it  is  very  likely  to  be  even.  However,  some  of  the  hollow  viscera,  as 
far  instance,  the  stomach,  may  be  inflated  with  gas,  in  which  case  you  would 
have  an  uneven  enlargement.  Further,  upon  inspection  you  will  find  whether 
or  not  any  one  organ  is  enlarged.  Sometimes  the  spleen  enlarges  enormously 
and  pashes  farther  and  farther  down  through  the  abdomen,  and  makes  a bulg- 
ing enlargement  in  its  locality.  Sometimes,  as  I have  said,  the  stomach  is  dis- 
tended with  food  or  with  gases,  and  quite  enormously  so.  Sometimes  diseases 
of  the  liver  cause  it  to  eulax’ge,  as  for  instance  in  sclerosis  of  the  liver.  The 


162 


liver  protrudes  down  below  the  ribs  from  enlargement  and  makes  a protrusion 
of  the  abdominal  walls,  as  does  also  enlargement  of  the  ovaries,  and  so  on. 
So  you  should  note  whether  or  not  the  enlargement  is  equally  disposed,  as  in 
gases  in  the  intestines,  or  is  at  a fixed  point,  in  which  case  you  will  learn  by 
other  methods  how  to  tell  what  organ  is  affected. 

We  should  also  note  the  temperature,  whether  or  not  parts  are  cold  or  hot. 
It  is  said  that  in  liver  troubles  there  are  often  cold  spots  upon  the  surface  of 
the  body,  and  we  know  that  in  cases  of  obstruction  to  the  nerve  supply  at  the 
spine,  you  can  trace  the  cold  streak  on  across  the  body. 

Inspection  will  reveal  to  you  the  color,  which  is  significant.  In  some 
cases  the  linea  alba  becomes  pale,  or  there  may  be  splotches  of  yellow  color  as 
in  some  diseases  of  the  liver,  jaundice,  and  in  other  eases.  In  pregnancy  the 
abdomen  assumes  a different  color,  brown,  yellowish  or  black  ; it  differs  ac- 
cording to  the  person.  You  can  make  out  the  outline  of  any  organ  and  locate 
it  by  the  other  methods  of  examination. 

The  abdomen  may  be  distended  or  it  may  be  retracted,  as  in  tubercular 
diseases  of  children,  where  it  is  said  the  abdomen  is  retracted.  And  you  will 
frequently  find  in  your  practice  that  in  thin,  emaciated  people,  any  disease 
that  is  wasting  is  liable  to  contract  the  abdomen.  You  will  also  find  that  in 
some  cases  it  is  distended.  In  diseases  which  affect  the  thorax  causing  pain 
upon  respiration  there  is  likely  to  be  a change  in  the  abdomen — anything  like 
inflammation  of  the  pleura  or  pneumonia,  there  is  restriction  of  motion  and  pain 
on  the  side  affected.  On  the  other  hand,  in  the  abdomen  when  you  have 
trouble  which  would  cause  pain  upon  motion,  as  for  instance,  in  peritonitis, 
you  have  the  restriction  of  motion  there,  and  increased  motion  in  the  thorax. 
You  can  also  by  this  examination  occasionally  note  changes,  even  through  the 
wall  of  the  abdomen,  as  in  cases  where  the  heart  has  been  displaced  by  some 
disease  in  the  thorax.  In  cases  of  aneurism  of  the  abdominal  aorta  you  can 
find  the  pulsation  of  the  tumor.  You  can  feel  it  very  frequently,  and  it  will 
sometimes  become  so  marked  that  you  can  detect  it  on  inspection.  The  caput 
medusae,  or  litttie  web  of  veins  about  the  umbilicus  may  become  enlarged  and 
engorged  with  blood,  indicating  that  somewhere  the  blood  is  interfered  with ; 
it  is  usually  in  the  liver,  as  in  ease  of  scirrhosis  of  the  liver,  but  it  may  be  in 
some  portion  of  the  ascending  vena  cava. 

Palpatation,  as  I have  said,  is  important  to  the  Osteopath.  You  can  feel 
the  different  solid  viscera  in  the  different  parts  of  the  abdomen.  As  I have 
already  mentioned,  you  can  feel  whether  or  not  there  be  tumors  of  any  kind  in 
the  abdominal  wall ; you  can  by  touch  differentiate  between  those  in  the  wall 
and  those  in  the  organs ; you  can  tell  whether  or  not  they  are  superficial  or 
deep,  fluctuating  or  solid.  A solid  tumor  will  give  a sound  as  you  get  over  the 
liver — a flat  sound ; a liquid  tumor  will  give  also  a flat  sound,  but  will  give  in 
addition  a fluctuation,  which  can  be  detected  by  palpatation.  When  the  abdo- 


163 


men  has  its  walls  retracted  it  is  likely  to  be  tense,  when  extended  thej'  are  also 
likely  to  be  tense.  In  other  cases  you  may  find  them  very  flabby,  very  loose, 
without  tone.  In  one  case  there  may  be  too  much  life,  in  the  other  case  a lack 
of  life  or  nerve  force,  and  you  can  detect  that  by  the  feeling.  You  can  also 
detect  displacement  of  parts  ; you  must  examine  to  see  if  the  parts  are  in  their 
normal  position.  The  liver,  of  course,  may  descend  considerably;  the 
stomach  may  be  displaced  until  it  is  resting  upon  the  floor  of  the  pelvis.  The 
spleen  may  be  enlarged  and  come  far  down.  Any  of  the  organs  may  indicate 
pathological  changes,  or  be  displaced  or  enlarged.  The  transverse  colon,  you 
know  where  to  And  it,  just  across  above  the  umbilicus.  It  sometimes  becomes 
loaded  with  fecal  matter  and  descends,  dragging  with  it  the  splenic  and  hepatic 
flexures,  and  in  such  case  you  will  be  able  to  make  out  those  flexures.  Yon 
will  also  be  able  to  make  out  fecal  tumors — accumulation  of  fecal  matter  in  the 
large  intestine.  If  there  be  pain  in  the  stomacn,  and  it  increases  upon  pressure 
over  the  pit  of  the  stomach,  it  is  said  to  be  inflammatory,  as  in  catarrh  of  the 
stomach  ; if  it  ceases  it  is  said  to  be  nervous. 

As  I have  said,  the  method  of  x>ercussion  is  an  important  one  in  examin- 
ation of  the  abdomen.  In  general,  percussion  over  joarts  which  are  distended 
with  gas,  gives  a tympanitic  sound  of  the  abdomen,  because  there  the  gas  is 
restricted  within  limits.  Over  a stomach  or  bowel  distended  you  get  a tj'm- 
panitic  sound.  Over  the  parts  contained  in  the  abdomen  you  get  a varying 
character  of  flat  sounds.  For  instance,  over  the  liver,  you  know  it  is  best 
reached  right  in  the  median  line,  below'  the  eusiform  cartilage,  we  get  a flat 
sound.  Here,  however,  over  the  lung,  you  get  a higher,  more  resonant  sound. 
You  can  compare  sounds  in  that  w'ay.  Over  the  region  of  the  spleen  we  get 
the  same  flat  sound;  over  the  region  of  the  stomach  likewise.  Over  the  in- 
testine, the  same,  except  the  note  is  of  a little  higher  quality.  Eemember  that 
in  using  your  left  hand  as  a pleximeter  it  is  best  not  to  place  the  whole  hand 
on  the  abdomen,  place  the  middle  Anger  on  the  abdomen,  and  then  bring  the 
lingers  of  the  right  hand  into  line,  or  take  the  middle  finger  of  the  right  hand, 
and  tap  gently  for  superficial  structures,  and  for  deeper  structures  more 
strongly. 

Measurements  are  used  but  little  in  our  examination  of  the  abdomen,  but 
you  can  take  the  umbilicus  as  a fixed  point  and  measure  from  it  to  the  an- 
terior superior  spines  of  the  ilia,  to  the  end  of  the  ensiform  cartilage,  or  to 
the  symphysis  pubis. 

Auscultation  is  made  little  of  in  the  books.  How  ever,  I think  we  use  it 
more  that  the  old  profession;  it  is  said  it  is  of  little  use.  Dr.  Harry  Still  uses 
it  very  frequently  in  cases  of  liver  trouble.  He  says  if  he  finds  a gurgling 
sound  over  the  liver,  there  is  trouble  there.  That  that  gurgling  sound  in- 
dicates that  there  is  an  obstruction  to  the  portal  circulation.  I have  often 
been  able  to  hear  this  gurgling  sound.  It  will  be  (juiet  for  a while  and  then 


164 


you  will  liear  a gurgling,  and  it  will  be  quiet  again  and  you  will  hear  the 
gurgling  again.  Of  course  I am  awai-e  you  might  confuse  this  with  the  bub- 
bling of  gases  in  the  stomach,  but  you  will  have  to  learn  by  general  indica- 
tions what  the  probabilities  are.  However,  I think  ausculation  in  that  way 
over  the  liver  is  useful  to  us  as  Osteopaths.  Ausculation  is  also  employed  to 
hear  the  fetal  sounds  in  pregnancy,  we  will  take  that  up  later.  Please  re- 
member also  that  you*must  take  into  consideration  the  conformation  of  the 
spine,  thorax  and  pelvis,  take  all  these  parts  which  will  in  any  way  affect  the 
abdomen  into  consideration  in  your  examination. 

It  is  difficult  to  say  just  how  to  give  a general  treatment  for  the  abdo- 
men, because  we  usually  treat  there  for  a specific  object.  However,  as  far  as 
a general  treatment  would  go  in  the  abdomen,  it  would  relax  the  walls.  I 
would  simply  lay  my  hands  on  the  abdomen  firmly;  I would  not  take  the  tips 
of  my  fingers,  I would  not  dig,  I would  keep  my  hands  straight  in  that  way; 
you  know  the  importance  of  that.  Thus  you  can  thoroughly  relax  all  the  sur- 
face of  the  abdomen.  We  know  this  is  a very  effective  movement;  it  is  hard 
to  explain.  ■ As  I said  at  the  last  lecture,  I believe  that  the  movements  there 
stimulate  the  nervous  mechanism  in  the  abdomen  more  than  anything  else; 
and  mechanically  of  course  we  cannot  help  but  work  the  blood  to  the  j>arts. 
It  is  said  to  be  very  beneficial.  It  is  recommended  by  physicians  in  general 
just  to  tap  the  abdomen  lightly  all  over.  The  masseur  works  the  abdomen 
considerably  in  case  of  constipation,  and  that  mechanically  excites  a flow  of 
blood.  That  is,  if  it  is  mechanical,  but  it  is  hard  to  believe  it  is  very  largely 
in  that  way.  There  is  also  another  movement  we  might  include  in  the  general 
treatment  of  the  abdomen,  that  is,  a lifting  up  motion,  you  can  thrust  yoiir 
hands  down  in  deep  in  the  iliac  fossa,  and  raise  everything  there.  You  can 
in  that  way  raise  the  uterus,  bladder  and  bowels.  That  is  frequently  an  ex- 
cellent method  of  treatment  and  has  been  used  with  great  success. 

Next  as  to  examining  and  treating  the  important  organs  contained  within 
the  abdomen.  First,  as  to  the  stomach.  It  is  hard  to  confine  yourself  to  a 
particular  part.  The  stomach,  for  instance,  gives  symptoms  in  all  parts  of 
the  body.  We  should  notice  the  face,  the  expression  and  the  complexion; 
there  may  be  lack  of  color,  a yellow  or  clay  colored  complexion.  Also  notice 
the  eyes,  the  odor  of  the  breath,  the  appearance  of  the  tongue.  All  these 
things  are  indicative  in  troubles  of  the  stomach.  Also,  of  course,  vomiting, 
the  belching  of  gas,  and  so  on.  But  these  things  are  so  familiar  to  you  that 
I need  but  mention  them  to  you  in  the  treatment  of  the  subject  in  this  way. 
However,  more  particularly  as  to  the  ^stomach  locally.  Of  course  you  have 
the  point  already  that  you  can  see  by  inspection  whether  or  not  it  it  enlarged. 
You  can  also  notice  by  palpation  whether  or  not  it  be  enlarged,  by  percussion 
whether  or  not  it  is  caused  by  solids,  fluids  or  gases.  Now,  in  treatment  of 
the  stomach,  you  know  already  that  our  chief  treatment  is  over  the  splauch- 


165 


nics;  I have  already  indicated  to  you  the  manner  in  whieh  we  treat  the 
splauchnics.  We  also  go  to  the  solar  plexus,  treating  by  pressing  in  deeply 
below  the  end  of  the  sternum,  over  what  is  called  the  pit  of  the  stomach,  a 
pressure  of  five,  six  or  eight  pounds,  and  thus  impinge  upon  the  solar  plexus, 
and  you  thus  get  an  effect  on  the  stomach,  since  the  plexus  has  control  of  the 
coeliac  blood  supply,  as  well  as  various  other  blood  vessels  in  the  abdomen. 
Sometimes  we  treat  the  stomach  mechanically  by  raising  the  ribs,  as  we  would 
on  the  right  side  in  liver  trouble.  It  is  the  usual  motion  of  raising  the  ribs. 
Or  you  can  set  the  patient  up,  have  him  take  a deep  breath  and  put  the  fin- 
gers in  gently  under  the  ribs  and  raise  \ipward  and  outward,  thus  freeing  the 
parts  in  that  way.  Of  course  in  any  treatment  we  wish  to  reach  the  splanch- 
nics,  the  solar  plexus,  and  it  is  said  there  is  an  important  point  in  the  neck. 
Of  course  we  also  reach  the  vagi  along  the  sides  of  the  neck  and  behind  the 
clavicle,  where  the  vagus  crosses  the  first  rib.  At  the  atlas  it  is  said  a dis- 
placement to  the  right  will  interfere  with  the  right  vagus.  In  the  case  of 
nausea  we  inhibit  upon  the  left  side  between  the  fourth  and  fifth  ribs.  You 
know  how  to  find  these  interspaces.  I simply  thrust  my  thumb  into  that  in- 
terspace. The  spine  of  the  scapula  is  opposite  the  third,  then  coming  down  a 
little  ovei'  an  inch,  yon  will  readily  be  able  to  find  where  the  interspace  is; 
then  you  must  raise  the  arm  a little,  just  enough  to  relax  those  parts,  and 
thrust  the  thumb  deeply  in  that  interspace.  That  is  one  way  of  treating 
nausea,  but  it  depends  npon  the  cause.  I have  had  cases  of  nausea  in  which 
that  would  not  succeed,  the  pressure  gave  no  relief,  but  general  work  npon 
the  splanchnics  would  give  relief.  That  was  a case  where  the  patient  was 
easily  susceptible  to  congestion  of  the  stomach,  and  such  treatment,  coiipled 
witn  treatment  of  the  vagi  in  the  neck  would  always  give  relief.  Treat  in  gen- 
eral the  back  from  the  third  or  fourth  dorsal  down  to  the  tenth,  eleventh  or 
twelfth.  Displacement  of  ribs  may  cause  the  same  trouble,  and  yon  may  also 
lind  a contracture  along  the  spine  on  either  side  which  will  cause  trouble  with 
the  stomach.  I treated  a case  some  time  ago  in  which  the  only  lesion  I could 
find  was  a contracture  of  the  muscles  on  both  sides,  there  was  a little  heaviness 
of  the  stomach,  which  disappeared  on  treatment.  You  may  find  exquisite  ten- 
derness over  the  region  of  the  stomach,  and  yon  can  see  on  pressure  whether  or 
not  that  may  be  nervous  or  inflammatory.  When  you  have  gas  in  the  stomach 
it  shows  there  is  a lack  of  life  in  such  a way  as  to  allow  the  food  not  to  be  digested 
and  pass  on  in  the  usual  way,  but  to  be  retained  and  thus  to  ferment  and  form 
gas.  It  is  said  to  free  the  stomach  of  its  contents  to  inhibit  the  pneumogastric 
between  the  fourth  and  fifth  ribs,  as  I have  shown  you,  and  in  that  way  yon  re- 
lax the  pylorus  and  allow  the  food  and  contents  to  pass  off.  Or  you  can  also 
do  the  same  thing  by  mechanical  work.  I thrust  my  hand  under  in  this  - way 
and  work  toward  the  large  end  of  the  stomach ; I then  bring  pressure  gradually 
toward  the  pyloric  end,  in  that  way  yon  can  force'onward  the  contents  of  the 


16(i 


stomach.  You  work  thus  over  the  ribs ; you  can  press  the  ribs  down  iu  that 
way  and  get  quite  a pressure,  and  you  can  also,  in  the  median  line,  work  very 
carefully  on  the  abdomen  ; you  can  thus  work  the  gas  or  liquid  from  the  stomach. 

This  deep  pressure  over  the  solar  plexus,  as  I have  already  shown,  is 
said  to  be  very  efficient  in  case  of  bloating  with  gas.  In  some  way  the  stim- 
ulation of  the  plexus  allows  the  gases  to  be  condensed,  and  that  is  one  of  the 
efficient  treatments  iu  cases  of  gas  on  the  stomach  or  bowels.  The  ninth  and 
twelfth  ribs  on  the  left  side  have  been  found  displaced  in  some  cases.  In  cases 
of  pregnancy,  menstruation  or  such  troubles,  you  will  frequently  find  a sick 
stomach.  Of  course  that  is  reflex.  To  treat  a sick  headache  which  is  caused 
from  the  stomach,  you  must  first  apply  your  treatment  to  the  stomach,  and 
thoroughly  stimulate  the  parts  there  before  attempting  to  work  on  the  head. 
In  cases  of  female  troubles,  you  may  give  relief  there,  and  it  is  well  to  do 
so,  but  of  course  you  must  work  upon  the  local  trouble  at  its  appropriate  cen- 
ters to  relieve  it. 

Now,  as  to  the  liver.  First  as  to  its  examination  ; you  cannot  see  any- 
thing by  mere  inspection  ; the  best  way  is  to  percuss  the  region  of  the  liver. 
If  you  find  behind  the  linea  alba  that  the  left  lobe  comes  down  as  much  as 
three  inches,  the  liver  is  either  prolapsed  or  enlarged,  and  you  will  have  to  de- 
termine which  is  the  case.  By  percussion  along  the  lower  edge  of  the  ribs  and 
up  over  the  ribs  as  high  as  about  an  inch  below  the  nipple  you  can  make  out 
the  outline  of  the  liver.  You  will  also  frequently  find  that  it  is  quite  tender, 
and  it  becomes  extremely  so  in  some  cases.  Dr.  Harry  Still  says  that  in  case 
the  liver  is  extremely  tender  he  always  looks  for  diarrhoea.  The  easiest  place 
to  find  whether  or  not  the  liver  is  tender  is  in  the  median  line  behind  the  linea 
alba.  Of  coirrse  the  liver  is  complicated  with  general  troubles,  as  for  instance, 
in  constipation  and  diarrhea ; these  two  things  indicate  the  derangement  of  the 
liver.  In  diseases  of  the  liver  you  will  frequently  notice  yellow  splotches  upon 
the  skin,  perhaps  on  the  face,  perhaps  over  the  abdomen ; you  will  find  a rush- 
ing of  blood  to  the  head,  double  vision,  or  day  blindness.  You  must  learn  in 
general  what  the  complications  are,  when  the  liver  is  deranged.  I have  noted 
already  the  fact  that  auscultation  is  frequently  used  in  examin.ation  of  the  liver. 
Just  place  the  ear  very  lightly  over  the  region  of  the  liver,  just  at  the  edge  of 
the  liver  you  will  be  able  to  make  out  a gurgling  if  there  be  such  there. 
Now,  as  to  the  treatment  of  the  liver  itself.  I have  already  shown  you  how  ve 
treat  the  liver — the  raising  of  the  ribs  as  shown  here ; or  have  the  patient  take  a 
deep  inspiration,  and  then  raise  the  points  of  the  ribs.  Dr.  Harry  Still  fre- 
quently employs  that  method — just  reaching  under  the  tips  of  the  ribs  and 
raising  them  upwards  and  outwards.  Of  coursh  you  will  have  to  lie  careful  in 
doing  that.  We  also  work  upon  the  liver  frequently  in  this  way:  You  can 

place  one  hand  beneath  and  tuns  raise  the  side  of  the  chest  toward  you,  and 
with  the  other  hand  press  down  with  the  flat  of  the  fingers  against  the  liver. 
Thus  you  can  press  the  ribs  down,  and  this  motion  is  very  good. 


167 


I explained  what  I believed  to  be  the  theory  of  such  work  the  other  day. 
Qf  course  in  treating  the  liver  we  must  remember  that  there  are  vaso-motor 
fibers  iu  the  pueumogastric,  and  we  must  not  omit  to  ti-eat  it.  We  also  treat 
the  splanchnics,  as  it  is  also  controlled  by  sympathetic  supply ; also  the  solar 
plexus.  Those  are  the  chief  points  for  reaching  the  blood  and  nerve  supply  of 
the  liver. Also  the  point  that  I gave  you,  upon  each  side  of  the  umbilicus,  it  is 
said  that  pressure  here  applied  not  too  deeply,  a fairly  firm  pressure,  will  reach 
those  centers  and  irtlueuce,  first,  the  kidneys:  second,  the  liver;  and  third,  the 
bowels ; you  can  get  an  influence  upon  all  those  organs  in  that  wa}’. 

As  to  the  gall  bladder  and  duct,  they  are  extremely  important  to  us.  As 
I have  said,  the  gall  bladder  is  behind  the  licer  here  at  the  point  of  the  ninth 
rib  on  the  right,  but  we  can  get  indirect  pressure  upon  it  by  working  up  under 
the  point  of  the  ribs,  for  instance,  you  can  sometimes  feel  the  prominence 
made  oy  the  fundus.  The  first  thing  in  working  upon  the  gall  bladder  is  to 
work  against  its  fundus,  and  we  can  work  upon  it  by  working  up  under  the 
ends  of  the  ribs.  Ttie  duct  we  have  already  spoken  of,  it  lies  upon  the  right 
in  a reversed  “S”  being  just  over  the  umbilicus,  to  the  left,  and  the  lower 
limb  of  the  “S”  around  the  umbilicus  to  the  right  where  it  empties  into  the 
duodenum.  Since  the  gall  bladder  and  its  ducts  are  both  lined  by  mucous 
membrane  and  like  mucous  membranes  iu  other  parts  of  the  body  it  is  liable  to 
catarrh,  it  follows  that  catarrhal  inflammation  may  sometimes  travel  from  the 
pharynx,  through  the  msophagiis,  stomach  and  intestines  and  up  into  the  gall 
bladder.  You  will  then  have  an  increased  secretion  of  mucous  in  the  gall 
bladder  and  duet,  and  may  have  a mncons  plug  shutting  up  that  duct,  result- 
ing in  jaundice.  Or  yon  may  have  a gall  stone  formed,  said  to  be  a precipita- 
tion of  the  cholesteriue  of  the  bile  ; these  solidify  and  close  up  the  duct.  In 
treating  for  them  we  work  as  I have  shown  you,  against  the  fnndiis  of  the 
bladder  and  along  down  the  duct,  simph-  trying  to  force  them  out.  Some- 
times they  are  quite  hard,  and  at  times  they  are  quite  soft  and  can  be 
crushed  iu  the  duct ; this  has  to  be  done  without  any  violence,  howevmr.  It  is 
said  that  in  treating  for  gall  stones,  you  should  not  end  your  treatment  without 
raising  the  ninth,  tenth,  and  eleventh  ribs  on  the  left  side  for  the  spleen ; that 
stimulation  of  the  spleen  seems  to  prevent  their  formation,  and  results  gotten 
there  seem  to  prove  that  line  of  argument. 

Q.  In  case  yon  wer’e  treating  the  vagi  iu  the  neck  and  the  patient  should 
be  taken  with  a nervous  chill  or  something  of  that  kind,  at  what  point  would 
yon  treat  to  counteract  that? 

A.  I would  treat  along  the  spine,  a general  treatment.  It  is  said  that  a 
rubbing  up  the  spine  in  this  way  is  good  for  a chill,  and  I would  work  there 
for  a chill,  stimulating  also  the  heart  and  lungs  to  stimulate  the  circulation. 

Q.  Has  it  been  the  experience  of  Osteopaths  that  by  stimulation  of  the 
vagi  it  would  increase  peristalsis  of  the  large  bowel,  and  stimulation  of  the 
great  splanchnic  would  decrease  it? 

A.  Yes  sir,  that  has  been  the  experience. 


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LECTURE  XXV. 

At  the  last  lecture  I took  up  the  examination  and  treatment  of  the  ab- 
domen and  its  contents,  first  showing  you  how  we  treat  to  affect  the  abdomen 
in  a general  way,  and  then  I started  to  take  up  the  contents  of  the  abdomen 
one  after  another.  I thought  I should  get  as  far  as  the  intestines  the  last 
time,  but  failed  to  do  so,  and  that  will  be  included  in  to-day’s  lecture.  I will 
also  take  up  the  consideration  of  the  pelvis  to-day. 

I.  Some  nerve  couuections  and  centers  for  the  iotestines  and  pelvic  con- 
tents. I have  already  mentioned  some  centers,  iu  the  list  given,  and  we 
should  always  consider  those  centers  along  the  spine  in  connection  with  the 
different  parts.  There  are  certain  vaso-motor  fibers  noted  in  Howell’s  Text 
Book:  First,  for  the  external  genital  organs  there  are  two  groups,  one  com- 

ing from  the  lumbar  region  and  the  other  from  the  sacral  region.  Those  of 
the  lumbar  region  from  the  second,  third,  fourth  and  fifth  lumbar  nerves,  run- 
ning forward  in  the  white  rami  communicantes;  they  pass  through  the  pelvic 
plexus,  and  thus  reach  their  termination.  You  will  see  later  that  this  pudic 
nerve  is  important  to  us  in  our  treatment;  you  know  it  contains  some  vaso- 
motor fibers  for  the  external  genitals.  As  for  the  sacral  group,  these  leave 
the  anterior  roots  of  the  nerves  in  the  sacral  region.  A stimulation  here 
causes  a dilation  of  the  vessels  of  the  external  genitals.  As  to  the  internal 
generative  organs,  vaso-constrictors  for  the  Fallopian  tubes,  uterus,  and 
vagina  in  the  female,  and  for  the  seminal  vesicles  and  the  vasa  deferentia  in 
the  male,  are  contained  in  the  sacral  nerves.  Also  we  get  some  fibers  from 
the  second,  third,  fourth  and  fifth  lumbar  nerves,  just  as  we  had  vaso-motor 
fibers  for  the  external  genitals.  We  want  to  know  the  following  points:  that 
the  second,  third,  fourth  and  fifth  are  the  same  for  the  external  and  internal 
genitals;  that  we  get  vaso-motor  fibers  from  both;  that  we  also  work,  as  you 
will  see  later,  in  consideration  of  the  pelvis  contents,  frequently  upon  the 
sacral  region,  springing  the  sacrum,  relaxing  the  ligaments  about  it,  and  also 
stimulating  the  peripheral  terminations  of  the  nerves  in  the  muscles  along 
the  sacral  region.  It  is  said  that  the  first  point  to  which  one  should  go  in 
treatment  of  female  troubles  is  the  fifth  lumber;  that  that  is  the  important 
point,  not  particularly  an  important  center,  but  the  place  where  it  seems  a 
displacement  is  likely  to  occur.  Then,  too,  you  know  that  that  is  the  center 
for  the  hypogastric  plexus.  The  next  important  point  is  the  second  lumbar, 
which  is  the  center  for  blood  supply  to  the  uterus.  After  that  in  treatment 
of  female  troubles  the  next  important  point  is  between  the  tenth  and  eleventh 
dorsal  vertebrte,  the  blood  supply  to  the  ovaries.  Hilton  makes  a f)oint  that 
the  muscular  abdominal  walls,  the  peritoneum  lining  all  these  walls,  and  the 
skin  over  them,  are  sui^plied  by  branches  of  the  same  nerves,  as  we  have  al- 
ready mentioned  the  point  that  he  makes  that  a joint,  the  muscles  moving  the 
joint,  and  the  skin  covering  the  insertion  of  those  muscles,  are  all  supplied  by 


169 


branches  of  the  same  nerve.  Hence,  it  is,  he  says,  that  retraction  of  the  ab- 
dominal wall  and  great  tenderness  of  the  skin  over  the  abdomen  is  fonnd  in 
cases  of  peritonitis,  the  inflammation  reaching  the  terminal  filaments  in  the 
Ijeritoneum,  extending  thus  from  the  branches  irritated,  the  sensory  branches, 
to  the  motor  branches,  causing  the  abdominal  walls  to  contract,  influencing 
also  the  external  cutaneous  branches,  causing  a feeling  of  pain  upon  touching 
the  abdomen.  That  brings  to  mind  the  iDoint  that  has  already  been  men- 
tioned to  some  extent,  and  which  was  brought  up  in  clinics  not  long  since. 
The  question  was,  can  you  imijinge  upon  the  sensory  part  of  a nerve  and 
thus  affect  its  motor  fibers.  I think  that  such  points  as  this  answer  that  very 
clearly.  Hilton  also  instances  a case  of  peritonitis,  in  which  the  cause  was 
obscure.  It  was  not  severe,  but  it  was  hard  to  tell  at  first  that  it  was 
peritonitis.  The  patient  had  been  having  pain  in  the  abdomen,  it  was  bi- 
lateral, there  was  no  heat  at  the  part;  he  therefore  decided  that  the  cause  was 
either  central  or  was  dDuble,  and  since  there  was  no  heat  thei’e,  he  examined 
for  spinal  trouble.  He  examined  thoroughly,  but  could  not  find  any  evidence 
of  disease  of  the  spine;  he  then  made  his  examination  for  fluid  in  the  ab- 
dominal cavity,  and  found  that  there  was  fluid  in  the  abdominal  cavity  irri- 
tating the  nerves  and  causing  this  pain  upon  the  abdomen. 

In  considering  the  pelvis,  I though  it  would  be  interesting  to  bring  out 
some  further  points  considering  nerve  connections  there.  I noted  the  point  the 
other  day  that  in  trouble  of  the  uterus,  ovaries,  etc.,  the  sympathetic  filaments 
suppljdng  these  parts  cany  the  irritation  back  to  the  spinal  nerves,  and  thus  it 
may  go  down  the  sciatic,  or  might  influence  the  nuicles  at  the  lower  part  of  the 
spine,  causing  lameness  there.  A further  point  is  noted  with  considerable  in- 
terest, and  it  may  be  useful  to  us  in  many  cases.  Hilton  noted  a case  in  which 
a gentleman  came  to  him  with  what  he  supposed  to  be  trouble  of  the  bladder 
and  urethra.  He  had  pain  externally  in  the  genitals  on  one  side,  and  he  traced 
the  pain  very  definitely  along  the  peripheral  branch  of  the  pudic  nerve,  along  the 
ramus  of  the  pubis  and  ischium,  to  the  genitals.  Hilton  traced  the  nerve  care- 
fully back  and  discovered  at  the  tuberosity  of  the  ischium  on  the  side  affected 
a thickening  of  the  tendons.  The  gentleman  had  been  used  to  sitting  upon  a 
hard  uneven  seat,  and  gradually'  there  had  formed  a thickening  of  the  tissues, 
whicn  had  impinged  upon  the  nerves  and  caused  this  pain.  As  you  know, 
there  is  a bursa  over  the  tuberosity  of  the  ischum  for  its  protection,  and  irrita- 
tion or  excessive  use,  or  sitting  upon  a hard  seat,  or  weight  unevenly  distributed, 
will  cause  similar  troubles.  It  may  be  that  an  Osteopath  would  go  back  to  the 
spine,  but  if  he  did  not  find  a lesion  there,  the  next  best  thing  would  be  to  go  to 
the  nerve,  and  see,  especially  at  the  tuberiosities,  if  there  was  not  some  trouble. 

II.  Landmarks  About  the  Pelvis  and  Peritoneum. — You  are  all  famil- 
iar with  the  location  of  the  anterior  superior  spine  of  the  ilium.  It  is  used  by 
surgeons  as  a point  from  which  to  measure  the  length  of  the  limhs,  which  you 


170 


kuow  is  quite  a hard  thing  to  do  successfully,  so  many  things  make  changes  in 
the  length  of  the  leg.  Holden,  however,  says  he  finds  it  more  reliable  to  take  a 
tape  line  and  have  the  patient  hold  it  between  his  teeth,  then  measure  a fixed 
point  on  the  limb  somewhere,  (he  measures  to  the  inner  malleolus)  not  swinging 
the  tape  from  one  side  to  the  other,  but  making  an  independent  measurement 
each  time.  You  will  find  that  in  work  upon  the  pelvis,  and  in  examining  the 
legs  you  will  have  to  see  that  the  patient  lies  perfectly  straight  upon  the  table. 
One  good  way  is  to  assertain  whether  or  not  a line  drawn  transversely  between 
the  anterior  superior  spines  is  at  right  angles  to  the  axis  of  the  body;  you  will 
have  to  see  that  the  patient  is  perfectly  straight.  It  is  also  helpful  in  making 
a diagnosis  of  hip  Joint  disease  or  disease  about  the  hip  joint,  to  place  the  thumbs 
firmly  upon  the  spines  one  upon  each,  then  grasp  beneath  the  trochanters  with 
the  fingers,  and  you  will  be  able  to  examine  in  that  way  for  two  things;  whether 
the  two  sides  are  alike,  and  at  the  same  time  you  can  press  backward  upon  the 
the  spine,  a tenderness  behind  gives  evidence  of  diseases,  frequently  in  the  spine 
a tenderness  behind  gives  evidence  of  disease,  frequently  in  the  sacro-iliac  syn- 
chondrosis. 

The  spine  of  the  pubis  is  also  familiar  to  jmu  in  its  location.  It  is  not  al- 
ways easy  to  find  ; sometimes  you  can  find  it  by  pushing  the  lower  abdominal 
skin  backward  towards  the  direction  of  the  spine ; if  not  successful  then,  by  ab- 
ducting the  limb  slightly,  causing  the  abductor  lougus  to  be  tensed,  you  can  feel 
its  attachment  to  the  spine.  Frequently  it  is  difficult  to  distinguished  between 
two  kinds  of  hernia,  the  inguinal  and  femoral,  but  it  is  said  that  in  case  of  in- 
guinal hernia  the  spine  of  the  pubis  is  on  the  outside  of  the  neck  of  the  sack, 
while  in  ease  of  femoral  hernia  it  is  on  the  inside.  That  may  be  a helpful 
point. 

The  perineum  has  a ligamentous  and  osseous  boundry;  it  is  bounded  by  the 
rami  of  the  pubes  and  isehia,  the  tuberosities  of  tne  ischia,  and  the  great  sacro- 
sciating  ligaments,  and  the  tip  of  the  coccyx  behind.  It  is  important  in  our 
practice,  I have  not  seen  the  point  mentioned  in  books,  that  we  should  note  the 
shape  of  the  perineum.  In  the  normal,  healthy  perineum  there  is  a slight 
bowing  upward  to  hold  up  the  pelvic  contents.  In  disease  there  may  be  a re- 
laxation of  the  ligaments  of  the  perineum  and  a dropping  down  of  the  contents, 
causing  a bulging  of  the  perineum.  Of  course  the  bulging  is  slight  whether  it 
is  normal  or  abnormal, but  it  is  important ; those  things  something  cause  a great 
deal  of  trouble,  even  though  the  variation  from  the  normal  position  may  be 
slight.  In  treating  such  a case  we  go  to  the  pudic  nerve  where  it  crosses  the 
spine  of  the  ischium,  stimulating  just  where  it  crosses  the  spine,  and  its  per- 
ineal branches  running  to  the  perineum  cause  a contraction ; also  by  stimula- 
ting the  lower  sacral  nerves,  causing  a contraction  of  the  coccygeus  muscle  we 
thus  help  it  to  raise  the  bowel  and  the  pelvic  contents. 

Usually  along  the  x’egion  of  the  sacrum  we  find  the  posterior  superior 


171 


spines  of  the  ilia.  They  are  on  a line  which  would  pass  horizontally  through 
the  second  sacral  spine  and  they  also  mark  the  middle  point  of  the  sacro-iliac 
synchondrosis.  We  can  find  opposite  them  the  spines  of  the  sacrum,  down  to 
the  last,  and  the  two  tubercles  upon  the  last  just  where  it  ends.  The  third  sa- 
cral spine  it  is  said  is  the  limit  of  the  extent  of  the  membranes  of  the  cord  in 
the  spinal  canal  and  of  the  presence  of  the  the  cerebro-spinal  fluid  in  the  canal. 

The  prominence  of  the  gluteti  muscles  often  become  significant.  That  is, 
it  is  said  that  in  persons  of  ill  health  these  muscles  become  relaxed  and  flaccid, 
and  that  wasting  upon  one  side  is  an  early  symptom  of  hip-joint  disease,  which 
is  very  difficult  to  diagnose.  The  fold  of  the  buttock  is  the  name  given  to  the 
line  just  below  the  edge  of  the  gluteus  maximus  muscle,  between  it  and  the  up- 
per back  part  of  the  thigh,  and  it  is  said  that  in  this  fold  is  the  easiest  place  to 
bring  pressure  upon  the  great  sciatic  nerve.  Taking  a point  between  the  tro- 
chanter and  the  tuberosity  of  the  ischium,  and  press  in  deeply,  rather  nearer 
the  tuberosity  than  the  trochanter,  you  can  impinge  upon  the  nerve.  Often  a 
person  sitting  sidewise  will  have  the  leg  become  numb  because  of  impingement 
upon  the  nerve ; you  may  sit  upon  the  edge  of  a bench  and  injure  this  nerve  so 
so  as  to  cause  sciatica. 

A line  drawn  from  the  posterior  superior  spine  of  the  ischium  to  the  top 
of  the  trochanter,  when  the  thigh  is  rotated  forward,  marks  at  the  junction  of 
the  upper  with  the  middle  two-thirds,  the  emergence  of  the  gluteal  artery  from 
the  great  sacro-sciatic  notch,  and  it  is  at  that  point  that  you  can  determine  the 
top  of  the  notch.  The  pudic  nerve  and  artery,  as  you  know,  both  cross  the 
spine  of  the  ischium.  This  is  located  by  drawing  a line  from  the  same  point, 
the  posterior  superior  spine  of  the  ischium,  to  the  outer  side  of  the  tuberosity 
of  the  ischium,  then  taking  the  junction  of  its  outer  and  middle  third,  you  have 
where  this  vessel  crosses  the  spine,  and  there  you  can  impinge  upon  it.  Of 
course  the  nerve  accompanies  the  artery,  and  that  is  an  importatant  point  to  the 
Osteopath,  for  there  you  can  stimulate  that  nerve  and  cause  contraction  of  the 
perineum.  The  point  is  mentioned  that  modern  methods  of  sitting,  enjoying 
one’s  self  in  an  easy  chair,  or  upon  soft  cushions  and  the  like,  causes  the  parts 
to  be  supported  more  by  the  soft  parts  about  the  hips,  so  that  pressure  could 
thus  be  brought  upon  these  blood  vessels,  especially  the  pudic,  and  that  a hard 
chair  is  much  more  healthful.  Upon  the  condition  of  these  nerves  depends  the 
blood  supply  to  the  interior  pelvic  organs.  Pressure,  brought  by  sitting,  upon 
these  vessels  determines  the  flow  of  blood  into  the  pelvis  and  is  a fruitful 
source  of  uterine  and  pelvic  disorders. 

III.  Examination  and  Tkeatment  of  Abdominal  Contents — (Con- 
tinued)— As  to  how  to  diagnose  troubles  of  the  intestine,  you  will  learn  that 
better  in  symptomatology,  when  you  come  to  the  special  diseases.  However. 
I can  show  you  something  of  the  methods  employed.  It  is  obvious  that  when 
vou  have  a ease  of  constipation,  diarrhoea,  flux,  or  anything  of  that  kind,  where 


172 


the  trouble  is.  The  nerve  supply  for  the  intestine,  as  you  know,  is  through 
the  sympathetics  from  the  upper  dorsal  down  ; that  is,  from  the  third  dorsal 
down,  because  we  get  the  vaso-motors  to  the  mesenteric  vessels  from  the 
splanehnics,  and  we  reach  the  sympathetic  connection  all  the  way  down  the 
spine.  1 have  already  shown  you  how  to  treat  those  parts.  We  also  reach  it 
by  working  on  the  solar  plexus,  and  you  can  get  an  immediate  effect  by  work- 
ing upon  the  centers  either  side  of  the  umbilicus.  In  all  these  ways  we  may 
reach  the  intestine.  Stimulation  of  the  sympathetics  will  inhibit  the  vermicular 
motion  of  the  bowels,  while  stimulation  of  the  pneumogastric  will  increase  the 
motion.  Of  course  you  know  that  in  working  upon  the  region  of  the  intes- 
tines we  also  work  upon  Auerbach’s  and  Meissner’s  plexuses.  There  is  a 
treatment  that  we  use  sometimes  in  case  of  constipation,  trouble  with  the 
bowels,  that  is,  we  begin  at  the  left  iliac  fossa,  and  by  deep  pressure  over  the 
line  of  the  colon,  work  gradually  upward  along  the  left  lumbar  region  where 
the  intestine  runs  over  the  kidney,  then  across  just  above  the  umbilicus,  and 
down  the  right  lumbar  region;  that  is,  we  work  there  largely  for  mechanical 
effect ; to  soften  the  fecal  matter  and  work  it  outward  as  we  go,  beginning  near 
the  orifice.  Of  course  it  is  impossible  not  to  impinge  upon  the  nerve  plexuses 
and  not  to  influence  Auerbach’s  and  Meissner’s  plexuses  in  working  upon  the 
intestines  there.  You  will  very  frequently,  according  to  the  season  of  the 
year,  which  wdll  soon  be  upon  us,  come  across  cases  of  cramps  and  diarrhea. 
It  is  not,  however,  limited  to  particular  seasons  of  the  year,  I have  found 
cases  of  bad  cramps  in  the  abdominal  contents  where  it  was  almost  periodic, 
you  might  say;  it  came  on  every  two  or  three  months;  after  some  indiscretion, 
as  over  eating  or  eating  of  too  rich  food  the  patient  would  have  those  attacks. 
The  spasm,  as  near  as  I could  make  out,  is  most  liable  to  occur  in  the  trans- 
verse colon;  it  starts  there  first  and  there  is  an  irritation,  from  that  point  the 
irritation  will  pass  down  through  the  bowel,  and  the  next  morning  or  the  sec- 
ond morning  you  will  have  tenderness  and  pain  down  in  the  region  of  the 
right  iliac  fossa.  It  has  been  my  experience  that  it  takes  that  course;  and 
from  there  it  will  spread  over  the  bowel  and  you  will  have  a case  similar  to 
to  an  inflammation,  I think  it  is  an  inflammation,  from  the  fact  that  the  pa- 
tient usually  passes  mucous  upon  convalescence.  This  trouble  can  be  very 
readily  stopped.  It  is  done  by  inhibiting  the  splanehnics;  you  can  have  the 
patient  sit  upon  a chair  and  hold  closely  all  along  the  region  of  the  splanch- 
nics,  just  by  a deej)  pressure,  hold  at  each  point  for  a minute  or  two  and  you 
wdll  be  able  in  that  way  to  stop  the  spasm.  I have  seen  it  disapjjear  in  a 
very  short  time.  The  same  thing  can  of  course  be  done  by  placing  one  knee 
along  the  splanehnics  and  drawing  the  arms  up  and  back.  Of  course  that 
brings  deep  pressure,  and  very  forcible,  against  the  splanehnics  and  inhibits 
them.  Particularly  it  is  the  upper  splanehnics  we  wish  to  reach,  but  it  does 
no  harm  to  work  ou  down  the  sp'ne.  It  is  not  a bad  idea  to  adopt  this  twist- 


173 


ing  motion,  because  if  there  is  a tightening  and  irritation  of  those  nerves,  you 
will  be  able  to  relax  them  i2i  that  way,  and  I have  been  able  to  in  that  way 
get  very  good  results  with  such  trouble.  There  is  another  thing  that  comes 
to  us  very  commonly,  and  that  is  flux  and  diaixhea.  The  center  for  the 
bowels  in  such  cases  it  is  said  in  opposite  the  lower  two  ribs  on  each  side, 
and  I do  not  know  what  the  control  is  there,  but  we  work  by  inliibiting,  by 
getting  deep  pressure,  just  as  I have  shown  you.  Have  the  patient  sitting 
up,  and  you  can  place  your  knee  against  the  eleventh  and  twelfth  ribs  and 
pull  the  arms  up  and  back,  and  then  against  the  other  side;  you  can  thus  in- 
hibit the  peristalsis.  It  is  undoubtedly  through  the  sympathetic  connection 
there  and  inhibition  of  the  sympatheties.  I never  omit  in  such  cases  to 
spring  the  spine,  and  to  spring  it  strongly;  that  is  one  of  the  cases  where  we 
have  to  give  a strong  treatment,  so  I have  the  patient  on  the  side,  reach  under 
tJie  spine  and  spring  the  column  ui)  toward  me  strongly,  all  along  the  lumbar 
region.  It  is  very  helpful  also  to  adopt  this  method  in  such  cases:  with  the 
patient  upon  his  side,  have  the  thighs  bent  up  and  get  a good  hold  against 
the  sacro-iliac  articulation,  and  spring  enough  to  raise  the  patient  from  the 
table.  I think  you  can  see  from  the  motions  I have  given  you  about  what 
you  can  do  in  such  cases.  Also  in  such  cases  never  forget  to  work  upon  the 
liver,  I have  already  shown  you  how  to  reach  that,  and  influence  it,  especially 
the  flow  of  the  bile.  It  does  not  make  much  difference  whether  the  patient  is 
constipated  or  whether  he  has  flux  or  diarrhea,  the  presence  of  bile  in  the  in- 
testine is  undoubtedly  helpful.  In  cases  of  constipation  the  “Old  Doctor’’ 
says  the  bile  is  nature’s  aperient,  and  that  it  helps  to  stimulate  the  peristalsis. 
In  the  other  case  the  action  of  the  bile  in  the  intestine  seems  to  be  such  as  to 
allay  the  irritation  or  the  inflammation.  It  simply  amounts  to  restoring  the 
normal,  in  one  case  you  have  a lack  of  bile,  and  the  normal  action  of  the  bowel 
seems  to  be  dependent  upon  it  for  stimulation.  In  the  other  ease  you  must 
work  to  cause  a flow  of  bile  also.  Just  why  it  works  differently  it  is  very 
hard  to  explain,  unless,  as  I say,  it  is  the  normal  condition  of  the  bowel  to 
have  the  bile  present  at  certain  intervals,  and  if  that  bile  is  lacking,  you  may 
have  various  effects.  I had  a very  interesting  case  not  long  since,  a gentle- 
man who  some  years  ago,  I think  about  three,  had  a case  of  bowel  trouble, 
diarrhea  and  considerable  trouble  at  that  time,  severe  trouble.  Since  then  he 
had  had  j)ain  after  eating,  say  about  three  hours  after  a meal,  also  bloody  flux 
at  stool.  This  had  been  troubling  him  off  and  on  ever  since  he  had  the  old 
trouble.  Upon  examination  the  only  difficultj’  that  I could  find  was  tighten- 
ing along  the  lower  lumbar  region,  making  a smooth  place  in  the  spine, 
which  I have  already  described  to  you.  Besides  that  the  eleventh  and 
twelfth  ribs  on  each  side  were  approximated,  forced  together,  so  that  you 
could  feel  but  very  little  interspace  between  them.  In  the  first  treatment  I 
did  all  I could  to  spring  the  lower  part  of  the  spine  and  to  relax  the  tissues 


174 


in  that  region,  and  also  adopted  motions  already  sho'n'n  to  separate  the 
eleventh  and  twelfth  ribs.  After  that  treatment  the  pain  after  eating  ceased 
and  he  did  not  have  any  return  of  it.  The  next  treatment  was  given  about  a 
week  later  and  I repeated  the  same  j^rocess  at  that  time,  and  since  then,  at 
the  last  information  about  a week  ago,  he  had  had  no  return  of  the  trouble, 
and  that  was  about  two  weeks  after  the  treatment,  l^ow,  that  was  all  very 
simple,  it  was  merely  looking  to  see  where  things  had  departed  from  the  nor- 
mal, and  restoring  them  and  relieving  the  tension  upon  the  parts.  One  thing 
that  I did  in  that  ease  was  to  relax  the  ligaments  in  this  way,  by  springing 
the  lumbar  region,  and  working  the  limbs  first  uj)  in  that  way  and  then  down. 
You  will  learn  these  motions  and  how  to  apply  them.  It  seems  that  in  some 
certain  kinds  of  trouble  one  motion  is  more  efficatious  than  another,  and  you 
will  also  find  that  it  varies  with  your  patient.  I also  in  that  case  took  what 
I call  the  quarter  turn  to  relax  the  tension  between  those  ribs.  That  is,  I got 
the  legs  of  the  patient  in  my  arms,  and  turned  him  until  his  body  was  about 
tlii'ee  quarters  off  the  table,  then  let  him  slii)  down  and  around  back  on  to  the 
table  in  that  way,  straightening  the  legs.  I think  you  understand,  as  I 
showed  you  the  motion  before.  I think  I mentioned  the  point  that  a displaced 
coccyx  is  sometimes  the  cause  of  diarrhea.  There  is  also  another  important 
treatment  in  the  case  of  intestinal  troubles.  That  is,  you  may  raise  the  intes- 
tines almost  bodily,  especially  in  cases  where  there  is  a relaxation  of  the  ab- 
dominal walls,  where  yuu  find  the  transverse  colon  descended  below  the  um- 
bilicus, and  then  by  pushing  in  deeply  above  the  pubes  you  can  push  upward 
and  outward  and  thus  raise  the  abdominal  contents.  Another  motion  is  to  have 
the  patient  lie  on  the  side  and  then  to  reach  deeply  into  the  fossm  and  work  in 
on  the  right  side  under  the  caecum,  follow  it  up  and  spread  apart,  and  then 
work  in  the  same  way  on  the  left  to  raise  and  spread  out  the  sigmoid  flexure. 
That  is  frequently  a very  good  way  in  which  to  treat  troubles  of  the  intestine, 
especially  where  you  expect  any  sort  of  relaxation  allowing  the  bowel  to  drop  in 
that  way,  and  that  is  in  almost  every  case  where  you  have  had  intestinal 
trouble  that  has  been  going  on  for  some  time,  there  is  almost  always  a relaxa- 
tion of  those  ligaments  and  prolapse  of  the  bowel.  You  will  remember  that 
the  defecation  center  is  at  the  second  lumbar,  and  the  “Old  Doctor”  has  shown 
me  a good  point  in  how  to  reach  the  second  lumbar.  He  places  the  thumb  of 
one  hand  just  over  the  trochanter  or  just  above,  and  then  flnds  the  second  lum- 
bar by  counting  carefully  up  from  the  fifth  lumbar,  and  then  while  he  presses 
upward  the  trochanter  of  the  patient  with  the  hand  that  is  on  the  hip,  he  presses 
inward  with  the  other  hand  and  gives  a turn  to  the  second  lumbar.  Then  tak- 
ing the  same  point  for  one  hand,  and  reaching  under  and  raising  the  patient’s 
head  and  shoulders  you  can  thus  very  effectually  relax  the  second  lumbar. 
You  see  that  makes  the  second  lumbar  a fixed  point  and  you  swing  the  upper 
part  of  the  trunk  around  it.  and  in  the  other  place  you  swing  it  in  much  the 


175 


same  way.  Robinson  makes  quite  a point  of  the  fact  that  what  he  calls  the  fe- 
cal reservoir,  viz.,  the  left  half  of  the  transverse  colon  and  the  descending 
colon  and  the  sigmoid  flexure,  are  all  supplied  by  the  inferior  mesenteric 
ganglion.  This  inferior  mesenteric  ganglion  is  found  on  the  inferior  mesen- 
teric artery,  and  you  can  reach  it  by  working  a little  toward  the  left  about  two 
inches  below  the  umbilicus.  We  have  very  good  results  in  cases  of  constipa- 
tion by  working  in  there  with  such  motions  as  this,  and  this  stimulates  that 
plexus ; the  inferior  mesenteric  ganglion  of  the  sympathetic.  In  speaking  of 
the  use  of  bile  it  is  not  only  helpful  in  cases  of  diarrhea,  flux  and  constipation, 
but  that  is  our  way  of  destroying  entozoa,  tape  worms  or  seat  wmrms  or  para- 
sites of  any  kind,  it  is  said  it  is  always  beneflcial  to  stimulate  the  flow  of  bile  in 
such  cases,  and  very  frequently  that  is  all  that  is  necessary,  thus  causing  the 
worm  or  whatever  it  is  to  be  acted  upon  by  the  bile.  In  treatment  of  con- 
stipation you  will  frequently  find  that  the  patient  is  simply  in  trouble  because 
he  has  not  drank  enough  water,  and  that  is  why  very  frequently  it  is  necessary 
to  prescribe  so  many  glasses  of  water  in  a day,  jmu  can  say  mineral  water  or 
spring  water,  or  something  of  that  kind,  so  they  will  think  you  are  particular 
about  it.  It  is  said  that  the  explanation  of  why  drinking  of  water  is  beneflcial 
in  cases  of  constipation,  is  that  when  the  stomach  is  empty,  the  water  should 
be  used  one  half  hour  before  breakfast,  that  the  water  passes  into  the  intestine 
and  is  easily  absorbed  by  the  lacteals  and  carried  to  the  portal  circulation,  and 
that  stimulates  the  flow  of  bile  and  increases  its  quantity,  and  thus  it  affects  the 
fecal  contents. 

As  to  the  treatment  of  the  spleen,  I have  already  shown  you  that  at  the  last 
lecture.  You  will  find  that  there  is  a tenderness  along  the  spine  behind,  and 
in  front  along  the  region  of  the  ninth,  tenth  and  eleventh  ribs  on  the  left  side 
in  such  cases,  and  Dr.  Harry  Still  tells  me  that  in  such  cases  it  has  been  his  ex- 
perience to  find  a cold,  clammy  perspiration,  especially  on  the  left  side  of  the 
body.  What  we  do  there  1 have  already  explained,  raise  the  ninth,  tenth  and 
eleventh  ribs,  and  work  carefully  under  the  tips  of  the  lower  ribs  in  front.  As 
I explained  at  the  last  lecture,  the  vaso-motor  supply  of  the  spleen  is  not  un- 
derstood, but  it  was  stated  that  we  changed  its  size  by  work  upon  the  peripheral 
terminals  of  the  splanchnics,  but  it  is  undei’stood  also  that  there  is  a center  in 
the  medulla,  there  is  also  a center  in  the  medulla  for  the  intestines  and  it  seems 
that  some  trouble  with  the  atlas,  or  some  tightening  of  the  ligaments  may  im- 
pinge upon  the  sympathetics  and  thus  get  an  effect  either  through  the  medulla 
or  directl}^  through  the  sympathetic  system. 


LECTURE  XXVI. 

At  the  last  lecture  I was  following  the  subject  of  examination  and  treat- 
ment of  the  abdominal  contents.  I shall  pursue  that  subject  farther  to-day. 


176 


taking  up  also  the  pelvis,  its  examination  and  treatment,  particularly  with  re- 
gards to  slips  or  twists  of  the  pelvis  as  a whole  and  of  the  innominate  bones. 
We  had  gotten  as  far  as  to  the  kidneys.  To  treat  the  subject  in  a general  way 
we  can  only  say  that  in  general  where  there  is  trouble  with  the  kidneys  there  is 
a tenderness  in  the  back,  freequently  contractures  or  displacements  along  the 
spine.  There  are  general  symptoms  which  you  will  learn  to  recognize,  and 
which  jmu  will  find  by  urinalysis,  which  you  have  learned  elsewhere.  Also  such 
things  as  odor  of  the  breath,  and  condition  of  the  tongue,  it  is  said  that  a fur- 
rowed or  ridged  tongue  indicates  kidney  disease.  The  complexion,  and  various 
things  of  that  kind,  are  indications  of  kidney  disease ; also  fever,  especially  fol- 
lowing suppression  of  the  urine,  since  then  the  system  is  poisoned.  Often 
you  have  painful  micturition  due  to  bladder  or  kidney  disease,  and  so  on.  The 
chief  thing,  however,  is  how  we,  as  Osteopaths,  treat  the  kidney.  The  nerve 
supply  is  largely  through  the  renal  splanchnics,  the  last  splanchnic  rising  oppo- 
site the  twelfth  dorsal.  I have  already  shown  you  how  we  should  work  there. 
Also  the  second  lumbar  is  the  center  for  micturition,  and  the  effect  that  we  get 
by  working  upon  the  second  lumbar  is  probably  a vaso-motor  effect,  since  you 
know  that  vaso-motors  leave  the  spine  all  the  way  down,  especially  from  the 
sixth  dorsal  to  the  second  lumbar,  having  both  vaso-dilators  and  vaso-constric- 
tors  within  those  limits.  A lesion  at  the  atlas  also  effects  the  kidneys,  probably 
by  an  effect  upon  the  renal  center  in  the  medulla.  Hence,  we  always  examine 
to  find  whether  or  not  the  atlas  is  displaced,  and  if  not,  we  are  able  to  get  an  ef- 
fect upon  the  renal  center  in  the  medulla  by  working  on  the  superior  ganglion 
and  in  the  sub-occipital  fossa.  Hence,  we  get  a sympathetic  effect.  Now,  a 
lesion  in  the  cervical  region,  especially  at  the  upper  part,  at  the  atlas,  may  affect 
the  kidney  directly  through  the  sympathetics,  and  indirectly  through  the  center 
in  the  medulla. 

One  of  the  best  ways  to  treat  the  kidneys  is  the  method  employed  bv  Dr. 
Harry  Still;  have  the  patient  upon  the  back,  with  the  knees  raised,  you  then 
have  all  the  muscles  relaxed.  Then  by  lifting  along  in  the  region  of  the 
lower  splanchnics,  simply  raising  the  patient  upon  the  fingers  and  springing 
outward  as  you  go,  you  relax  the  contractions,  and  spring  the  ligaments  and 
get  a general  stimulating  effect  upon  the  kidneys.  You  will  find  that,  I think, 
one  of  the  best  treatments.  Another  tieatment  is  to  press  here  at  the  umbilicus, 
and  by  pressing  deeply,  spreading  and  stimulating  probably  the  sympathetic 
ganglia  upon  the  renal  vessel,  as  there  the  renal  ganglia  occur.  Also  the  cen- 
ters which  I have  before  mentioned,  oceuring  one  on  either  side  of  ttie  umbilicus 
in  the  skin,  called  penntoneal  centers,  have  an  effect  upon  the  kidneys,  and  I 
do  not  doubt  but  that  we  get  some  sort  of  a mechanical  effect  also  in  this  way, 
by  relieving  any  pressure  which  may  be  brought  upon  the  renal  vessels.  Of 
course  there  are  other  things  that  may  bring  mechanical  pressure  upon  the  renal 
vessels,  such  as  aneurism  of  the  abdominal  aorta,  an  enlargement  of  some  one  of 


177 


the  aneurism  of  the  abdominal  aorta,  an  enlargement  of  some  of  the  abdominal 
organs,  or  tumors,  and  in  those  eases  you  must  direct  your  treament  to  the  con- 
ditions which  are  producing  the  disease.  You  will  frequently  come  across  cases 
of  renal  colic,  that  is,  stone  in  the  kidney  or  in  the  bladder,  and  in  the  passage 
of  the  stone  down  the  ureter  the  pain  is  excruciating.  Renal  colic  is  the  name 
given  to  the  pain  caused  by  the  passage  of  the  stone.  Of  course  the  deposit 
varies,  sometimes  the  stone  is  large,  and  it  varies  in  composition.  I do  not 
need  to  go  into  that,  as  that  is  not  the  purpose  of  this  lecture ; sometimes  it  is 
a crystal  of  uric  acid  about  which  deposits  aggregate,  and  in  the  long  run  there 
is  quite  a large  stone.  As  to  the  proper  treatment  for  it,  when  a stone  is  started 
from  the  pelvis  of  the  kidney  down  the  ureter,  it  is  our  treatment  to  work  along 
the  course  of  the  ureter  and  to  work  it  back,  if  it  is  possible,  because  you  can 
disolve  it  as  well  in  the  kidney  as  you  can  if  you  press  it  on  down  to  the  blad- 
der. Of  course  if  it  has  started  on  down  the  ureter  and  can  not  be  worked 
back,  it  should  be  worked  on  down  into  the  bladder.  Y u know  what  the 
course  of  the  ureter  is,  from  about  the  level  of  the  umbilicus,  a couple  of  inches 
on  each  side,  down  obliquely  to  the  base  of  the  bladder.  Of  course  I do  not 
mean  to  say  that  you  can  feel  the  uterer  by  working  along  its  course.  You  can 
however,  bring  aeep  pressure  along  its  course,  and  thus  work  upward  any  stone 
which  may  be  m it.  That  is  frequently  done.  In  such  cases  our  treatment 
would  be  directed  to  stimulating  the  general  health  of  the  kidneys,  that  is,  to 
inciease  its  healthy  action,  sc  that  these  stones  could  not  be  formed.  If  your 
kidney  is  acting  properly  }mu  will  not  have  renal  calculus.  Not  only  would 
we  take  care  of  the  renal  splanchnics,  and  the  second  lumbar,  but  all  along  the 
lumbar  and  lower  dorsal  region.  I have  tried  to  teach  you  that  j-our  lesion  ma\' 
be  at  the  center,  but  it  may  be  above  or  below,  causing  trouble  with  the  kid- 
neys. In  general  our  success  with  kidney  troubles  has  been  very  good.  Of 
course  when  you  come  to  general  treatment,  drinking  of  hot  water,  bathing, 
and  exercises,  are  all  good.  There  are  some  who  believe  that  it  is  beneficial  to, 
as  they  call  it,  tlush  the  kidney  every  morning  by  taking  a drink  of  water  be- 
fore breakfast.  That  acts  upon  the  kidneys  as  well  as  the  bowel.  It  is  proba- 
ble that  the  increased  excretion  would  tend  to  keep  the  kiduej's  flushed.  Byron 
Robinson  notes  that  fact,  but  does  not  give  it  the  weight  of  his  authority. 

As  to  examination  and  treatment  of  the  pelvis,  when  you  come  to  its  con- 
tents the  books  have  a great  deal  to  say,  but  as  to  the  pelvis  as  a whole  slipping 
or  becoming  twisted,  I have  not  seen  a word  about  that  in  any  books.  How- 
ever, that  is  an  important  thing  in  our  work.  The  pelvis  or  the  innominate 
bone  may  be  slipped  in  different  directions,  and  the  correction  of  these  slips 
gives  the  Osteopath  very  gratifying  results  indeed.  The  whole  pelvis  may  be 
slipped  forward  or  it  may  be  tipped  backward  in  the  first  place,  or  the  whole 
pelvis  may  be  twisted  from  side  to  side,  and  you  would  have  tenderness  on  each 
side  at  the  sacro-iliac  synchondrosis  particularly,  and  3^11  would  also  have  ten- 


178 


derness  at  the  symphysis,  for  the  reason  that  the  sacrum  is  broader  in  front,  as 
you  see,  and  movement  of  the  parts  then  would  tend  to  cause  the  wedge-shaped 
sacrum  to  act  upon  the  innominate  bone  and  press  them  apart,  thus  you  would 
have  a strain  at  the  symphysis,  and  you  would  have  tenderness  here  just  at  the 
symphysis.  In  examining  for  these  troubles,  always  pay  attention  to  the 
symphysis.  You  would  always  have  tenderness  where  the  ligaments  bind  the 
back  part  of  the  sacrum  to  the  innominate  bones.  If  it  is  tilted  backward, 
your  hand  when  it  has  become  able  by  touch  to  detect  the  departure  from  the 
normal,  will  find  that  the  posterior  portions  of  the  crests  of  the  ilia  are  project- 
ing farther  back,  and  when  tilted  forward,  that  the  posterior  portions  of  the 
crests  are  tilted  farther  forward,  so  that  you  will  come  to  find  out  whether  the 
position  is  correct  when  you  examine  bj'  palpitation,  which  is  our  general 
method.  Now,  if  the  pelvis  is  twisted  from  side  to  side  you  would  find  a tender- 
ness on  each  side,  at  the  saero-iliac  articulation  as  well  as  a tenderness  in  front, 
at  the  symphysis  and  you  will  have  to  judge  which  is  the  case.  Of  course  if 
the  pelvis  is  twisted  you  can  by  examining  the  back  get  an  indication  of 
which  way  it  is  twisted.  It  will  take  very  close  work  in  examination  and 
you  have  to  give  it  your  careful  attention.  The  reason  why  you  would  have  ten- 
derness on  each  side  is  tnat  in  a twist  of  the  pelvis  from  side  to  side  you  would 
have  both  ligaments  thrown  on  a strain,  one  diagonally  backward,  and  one  di- 
agonally forward,  and  you  would  get  tenderness  in  each  case.  When  you  have 
these  slips  and  twists,  of  course  you  have  something  then  that  is  affecting  the 
sacral  plexus  of  nerves,  and  the  result  maybe  pain  down  the  legs,  and  you  may 
have  sciatica  in  one  or  both  limbs,  and  the  most  fruitful  source  of  pelvic  disor- 
ders, especially  of  female  troubles,  is  a slip  of  the  innominate,  as  you  will  see 
later.  So  your  examination,  then,  would  include  both  the  symphysis  in  front, 
and  the  articulations  behind,  coupled  with  an  examination  for  general  disorders 
of  the  pelvis  and  even  down  into  the  limbs. 

Now^,  as  to  how  to  treat  the  pelvis  if  it  is  tilted  forward.  One  of  the  best 
ways  that  I know  of  is  to  set  the  patient  on  a chair,  and  then  by  putting  the 
knee  in  the  sacrum  behind,  we  can  reach  in  front  and  get  hold  of  the  anterior 
superior  spines"  and  pull  backwards;  it  does  not  take  a great  deal  of  force, 
and  at  the  time  it  is  quite  a good  movement  to  pull  the  patient  forward.  If  the 
pelvis  is  twisted,  of  course  then  the  lower  part  of  the  body  in  respect  to  the 
waist  is  turned  to  one  side  or  the  other.  One  of  the  best  ways  to  fix  that  is 
to  set  the  patient  on  a chair  and  get  the  arms  up  over  your  shoulder,  you  can 
sit  right  down  on  their  knees,  and  give  a twist  to  one  side  or  the  other,  sim- 
X)ly  making  an  effort  to  move  the  whole  trunk  of  the  body  upon  the  articula- 
tion with  the  pelvis,  and  as  that  is  rather  a moveable  point,  and  often  the 
point  of  displacement,  you  can  readily  turn  it  from  side  to  side.  You  can 
also  move  the  whole  pelvis  forward  by  some  such  motion  as  this:  have  the 
jDatient  lying  uijon  his  side,  you  can  make  a fixed  ijoint  with  one  hand  against 


179 


the  back  of  the  sacrum,  and  you  can  pull  the  limbs  backward  in  this  way; 
that  would  be  when  tlie  pelvis  was  tilted  backward.  Or,  you  can  get  the 
knee  in  the  back,  and  pull  back  on  one  side  and  then  on  the  other  with  the 
jjatient  lying  ui>on  his  side  as  well  as  to  set  him  in  the  chair.  Some  will  pre- 
fer that  method  perhai^s.  Then,  there  is  another  method;  of  course  there  are 
different  ways  in  which  you  might  do  this.  One  of  the  best  ways  which  I 
have  found  to  move  the  pelvis  with  the  patient  on  his  back,  is  to  fix  the  hand 
and  place  it  under  the  sacro  iliac  articulation  and  then  flex  the  thigh,  and  pull 
the  knee  down,  oiit  and  around  quite  strongly  and  thus  relax  the  ligaments  of 
the  articulation.  That  should  be  done  upon  one  side  and  then  upon  the 
other.  Our  experience  and  practice  has  taught  us  this  one  thing:  that  liga- 
ments are  extremely  important,  the  “Old  Doctor”  sets  considerable  store  by 
ligaments.  You  may  have  such  a thing  as  a cold,,  and  the  effect  upon  the 
ligaments  will  be  to  contract  them,  and  you  will  have  dislocations  of  the  parts 
affected,  from  that  simple  fact.  You  may  have  dislocations  of  the  pelvis  or 
of  one  of  the  innominate  bones.  I had  quite  a remarkable  ease  the  other 
day — there  was  almost  complete  paralysis  of  the  lower  limbs,  there  was  sen- 
sation and  some  motion,  but  there  was  very  little  motion,  the  patient  went 
about  in  a chair.  That  had  all  been  brought  on  by  la  grippe,  and  the  whole 
body  had  ceased  to  grow,  the  arms  were  thin  and  small,  the  face  and  head 
were  normal,  and  you  got  the  impression  of  looking  at  a dwarf  when  you  ex- 
amined the  patient.  So  it  is  that  a cold,  light  or  severe,  may  act  upon  the 
ligaments  and  contract  them  and  cause  displacement  of  the  parts,  and  there 
is  no  doubt  that  is  frequently  the  cause  of  displacements  of  the  pelvis,  as  of 
other  parts.  Yow,  I have  already  stated  that  not  only  may  the  whole  pelvis 
move  one  way  or  the  other,  but  one  bone  may  move  one  way  or  the  other. 
That  is,  the  whole  bone  may  be  slipped  up  or  down  or  it  may  be  tilted  back- 
ward or  forward.  However,  when  the  bone  is  tilted  forward,  you  will  see 
that  it  almost  inevitably  goes  somewhat  upward  on  account  of  tlie  shajte  of 
the  articulation  here  with  the  sacrum.  From  that  fact,  since  when  it  is  tilted 
somewhat  forward,  and  at  the  same  time  has  a tendency  to  slip  up  along  the 
back  part  of  the  articulation,  it  will  have  the  effect  of  shortening  the  leg. 
Consequently,  when  the  innominate,  not  the  pelvis  as  a whole,  is  slipped  foi  - 
ward  you  might  have  a shortening  of  the  leg.  Xaturally  you  would  sui^pose 
that  a slipping  forward  of  the  pelvis  would  lengthen  the  leg,  but  you  can  see 
from  what  I have  said  that  such  is  not  likely  to  be  the  fact.  Of  course  that 
would  change  the  normal  axis  of  the  parts.  The  various  axes  are  made  by 
juiietiou  of  the  sacrum  and  ilium  by  means  of  ligaments,  and  when  the  in- 
nominate bone  is  moved  in  one  direction  one  point  will  be  fixed  and  act  as  an 
axis,  and  another  point  will  be  fixed  and  act  as  an  axis  in  another  position  of 
the  innominate  bone.  That  subject  has  not  been  thoroughly  studied  out.  but 
it  is  a fact  that  when  the  innominate  is  slipped  forward  then  you  have  a 


18(» 


shortened  leg,  and  when  backward  you  will  probably  have  a lengthened  leg. 
Dr.  Harry  is  authority  for  the  statement  that  a twisted  or  tilted  innominate 
may  shorten  a leg  as  much  as  three  inches.  Of  course  a novice  looking  at 
such  a condition  would  think  at  once  that  the  hip  was  dislocated,  and  that  he 
had  one  of  those  wonderful  things  that  are  so  much  talked  of,  but  it  is  not 
always  the  case,  and  you  must  be  careful  in  your  examination.  One  of  the 
first  things  in  examination  is  to  make  these  motions  of  the  thigh  in  and  out, 
flexion  of  the  knee  up  toward  the  shoulder,  and  so  on,  for  the  purpose  of  re- 
laxing all  the  unnatural  tension  about  the  leg,  so  that  you  can  tell  whether  or 
not  the  limbs  are  similar.  Then,  getting  the  patient  straight  upon  the  table 
which  you  will  have  to  do  by  accuracy  of  your  eye,  you  can  of  course  judge 
whether  or  not  a line  drawn  between  the  anterior  superior  spines  is  at  right 
angles  to  the  direction  of  the  body.  Then  you  will,  by  taking  a certain  point, 
preferably  the  bottom  of  the  heels,  or  just  where  the  seam  runs  around  above 
the  heel,  note  whether  the  legs  are  of  the  same  length.  Of  course  you  will 
have  to  take  into  consideration  any  variation  in  the  thickness  of  the  heel, 
some  people  have  a thickened  heel  or  sole  put  on  their  shoes  for  the  very 
reason  that  their  limb  is  a little  shorter,  though  quite  as  frequently  the  con- 
dition has  not  been  discovered.  When  you  have  pain  in  the  lumbar  region 
of  the  back,  pain  in  the  hij),  or  in  the  leg,  or  in  the  sacral  region,  or  in  the 
external  genitals,  you  will  do  well  to  examine  to  see  whether  or  not  the  limbs 
are  of  the  same  length,  and  if  such  is  not  the  case  you  may  continue  the  ex- 
amination further  by  looking  to  see  whether  or  not  the  pelvis  or  one  of  the 
innominates  is  displaced.  When  you  come  to  measure  one  leg  by  the  other 
you  have  a variable  standard,  it  is  hard  to  tell  whether  or  not  one  leg  is 
longer  than  it  ought  to  be,  or  shorter.  So  you  have  to  take  means  of  deter- 
mining which  is  the  affected  side.  It  is  well  to  go  to  the  sacral  articulations, 
where  there  will  be  soreness  on  the  side  affected,  because  a greater  strain  has 
come  upon  the  ligaments  there,  and  you  vdll  also  have  a soreness  on  the  sym- 
physis on  the  side  affected.  You  will  frequently  have  a tension  and  some 
tenderness,  very  likely  from  contraction  of  muscles,  on  the  oijposite  side  from 
the  one  affected.  Taking  this  left  one  as  the  one  affected,  then  you  might 
have  a contracture  here  and  some  tenderness  on  the  right  side,  because  when 
you  have  one  thrown  out  of  position,  then  you  have  the  equilibrium  de- 
stroyed; there  has  to  be  readjustment  of  the  parts,  and  you  will  have  tension 
there  on  that  account,  but  I think  the  rule  given  you  will  indicate  to  you 
which  is  the  side  affected. 

As  to  how  we  may  remedy  the  defect  of  oue  innominate  being  slipped, 
there  are  various  ways  ; some  are  the  same  as  I have  shown  you.  As  I have 
said,  the  motion  thus  employed,  by  hexing  the  thigh  against  the  thorax,  plac- 
ing the  hand  firmly  under  the  pelvis,  and  pushing  the  knee  outward  and  down, 
thus  straightening  the  leg  again,  is  one  of  the  best  methods  T have  found.  After 


181 


you  have  done  that,  it  is  just  as  well  to  give  the  leg  a straight  pull,  not  a jerk, 
and  you  can  thus  bring  tension  upon  the  ligaments,  and  you  can  in  that  way 
frequently  straighten  mechanically,  and  1 think  you  can  get  a certain  nervous 
effect  that  will  relax  the  spasm.  It  is  just  like  putting  your  hand  upon  a con- 
tracture and  gently  inilling  against  the  contracture  until  you  have  relaxed  it, 
so  it  is  with  the  limb,  you  can  relax  the  spasm  of  the  muscles,  you  can  restore 
the  equilibrium  of  nerve  force,  and  it  will  return  to  normal.  That  is  one  way; 
another  way  is  for  the  operator  to  stand  in  front  with  the  patient  upon  the  side, 
then,  by  reaching  under  the  limb  and  grasping  the  tuberosity  below  and  the  an- 
terior superior  spine  above,  you  can  move  it  in  either  way  very  readily ; you 
can  slip  the  innominate  forward  or  backward  ; that  is  one  of  the  best  ways. 
You  can  in  that  way  stand  in  front  of  your  patient  and  do  your  work.  You  can 
get  behind  the  patient,  use  the  knee  as  a fixed  point  against  the  sacrum,  and 
then,  holding  against  the  anterior  superior  spine,  work  it  backward  in  that 
way.  When  you  stand  behind,  the  idea  is  that  you  can  work  to  draw  the  an- 
terior spine  toward  you.  Also  you  can  stand  behind  the  patient,  one  arm  be- 
neath the  thigh  of  the  patient,  making  a fixed  point  of  your  hand  against  the 
sacrum,  then  bend  the  leg  back  until  you  have  it  back  tc  a considerable  ex- 
tent, varying  the  degree  of  tension  according  to  the  patient.  That  is  one  very 
good  way  to  force  the  bone  forward.  Pressure  upon  the  sacrum  is  very  fre- 
quently employed  ; it  is  one  of  Dr.  Hildreth’s  very  common  treatments.  In  a 
great  many  cases  of  treatment  along  the  lower  part  of  the  spine  Dr.  Hildreth 
will  finish  by  putting  his  knee  against  the  sacrum  and  bringing  it  inward 
against  the  patient,  while  he  draws  the  pelvis  of  the  patient  back  towards  him. 
The  idea  being,  as  you  readily  see,  to  relax  the  ligaments  and  to  take  off  the 
tension  which  is  thus  brought  upon  the  branches  of  the  sacral  plexus.  From 
what  I have  said  and  from  combinations  that  j’our  own  ingenuity  will  suggest 
to  you,  you  can  remedy  the  defect  when  the  innominate  is  slipped  upward  or 
downward.  You  might  set  the  patient  upon  a chair  and  lift  upward,  at  the 
same  time  having  an  assistant  push  downward  upon  the  crest  of  the  innominate 
affected.  One  point  that  you  might  notice  in  regard  to  affecting  the  innomi- 
nate is  the  fact  that  the  quadratus  lumboriim  has  a tendency  to  help  matters 
along  by  its  contracture,  and  in  relaxing  the  tension  about  the  innominates 
when  displaced,  you  would  do  well  to  stretch  the  quadratus  lumborum.  That 
I have  shown  before ; give  it  the  diagonal  stretch  this  way  once  or  twice  and 
once  or  twice  the  other  way ; you  can  do  that  better  with  an  assistant,  because 
you  can  get  a better  tension.  I think  this  shows  the  value  of  steady,  firm  work 
over  the  body.  The  idea  of  working  with  jerks  is  bad,  because  as  a rule,  when 
you  give  a pull  or  a pressure,  the  idea  is  that  you  are  relaxing,  it  is  in  the 
nature  of  inhibition  of  nerve  force,  and  if  you  go  at  it  with  a jerk,  you  are  not 
only  liable  to  stimulate  instead  of  inhibit,  but  thus  set  up  a firmer  contraction, 
whereas  you  wish  to  relax. 


182 


In  treating  the  pelvis,  I have  already  noted  the  point  that  you  can  work 
upon  the  spine  of  the  ischium,  thus  impinging  directly  upon  the  pudic  nerve. 
I have  indicated  how  yon  should  find  that  point  by  a line  drawn  from  the  pos- 
terior spine  of  the  ilium  to  the  outer  side  of  the  tuberosity,  the  junction  of  the 
lower  with  the  middle  third  of  the  line  will  be  the  point  where  you  can  best 
impinge  upon  the  pudic  nerve,  and  then  by  relaxing  the  glutei  muscles  by  draw- 
ing the  limb  backward  some,  you  can  get  deep  pressure  at  that  point,  and  thus 
stimulate  or  bring  pressure  and  inhibition  upon  the  nerve.  Of  course  the  effect 
of  that  is  to  work  upon  the  perineal  branches,  and  through  it  to  cause  contrac- 
tion of  the  perineum  itself. 

As  to  the  bladder,  the  point  at  which  we  reach  the  hypogastric  plexus,  sup- 
plying the  fundus  of  the  bladder,  is  at  the  fifth  lumbar,  as  you  well  know.  And 
then  along  the  sacral  region  we  get  some  motor  fibers  to  the  bladder.  Along 
the  lumbar  region,  according  to  Quin,  we  get  motor  fibers,  particularly  to  the 
circular  fibers  of  the  bladder,  including  the  sphincter.  He  says  there  are  prob- 
ably also  to  aid  those  fibers,  inhibitors  to  the  longitudinal  fibers.  Thus,  work 
along  the  lumbar  region  would  affect  the  bladder.  An  inhibitory  effect  would 
be  to  relax  those  circular  fibers,  and  a stimulating  effect  would  be  to  contract 
the  circular  fibers.  In  the  sacral  region  the  Osteopath  takes  as  his  center,  the 
third  and  fourth  sacral,  and  he  works  there  to  relax  the  spineter  of  the  blad- 
der. It  is  stated  by  Howell’s  Text  Book  that  in  that  region  we  get  principally 
the  nerve  fibers  to  the  longitudinal  muscular  fibers.  So  you  see  there  is  a con- 
tradiction between  the  Osteopath  and  the  text  book.  However,  it  has  been  our 
practice  that  by  working  in  that  region  we  got  the  effect,  and  of  course  when 
theory  and  practice  conflict  we  must  take  practice.  There  is  a difference  be- 
tween the  text  book  and  what  we  have  found  in  practice  ; we  cannot  alwaj's 
make  them  agree.  It  is  stated  by  Howell’s  Text  Book  that  in  the  sacral  region 
and  in  the  lumbar  region  there  are  no  vaso-motor  fibers  given  off  to  the  blood 
vessels  of  the  bladder. 

It  is  hardly  worth  while  to  tell  you  how  to  examine  the  bladder.  Of  course 
you  know  where  the  bladder  is  situated ; when  distended,  it  will  rise  above  the 
pubes,  and  vou  will  likely  find  it  by  the  tumor,  and  on  percussion  you  will  get 
the  flat  sound  from  the  contained  fluid,  so  that  will  be  part  of  your  examina- 
tion, but  the  general  symptoms  which  you  will  get,  particularly  in  your  symp- 
tomatology and  in  urinalysis,  will  direct  you  in  your  examination  of  the  blad- 
der. If  you  have  a case  of  ammoniacal  urine  yon  will  be  able  to  recognize 
the  crystals  under  the  glass,  and  can  tell  whether  there  is  trouble  with  the 
bladder  in  that  way,  you  will  note  the  presence  of  bacteria,  setting  up  a de- 
compositiou  in  the  urine.  Several  months  ago  I examined  a samj^le  of  urine 
under  the  glass;  it  was  freshly  drawn  and  it  was  crowded  with  bacteria.  I 
directed  the  operator  who  brought  the  sami)le  to  boil  the  bottle  and  let  it  cool 
and  thus  have  it  completely  sterilized,  and  bring  me  a sample  as  fresh  as 


183 


possible.  He  did  so,  and  examination  showed  a great  number  of  bacteria, 
and  that  very  soon  after  obtaining,  the  urine.  This  indicated  the  presence  of 
bacteria  in  the  bladder,  setting  up  a decomposition  of  the  urine.  In  that  in- 
stance it  was  a case  of  bladder  instead  of  kidney  trouble,  as  had  been  thought. 
That  case  had  an  enlarged  lorostate;  the  prostate  had  acted  as  a partial  strict- 
ure to  the  passage  of  urine,  and  the  patient  had  used  a catheter,  had  not  taken 
any  precaution  to  keep  it  antiseptic,  and  had  thus  brought  about  a large 
amount  of  his  trouble.  The  operator  washed  out  the  bladder  with  some  anti- 
septic solution  and  reduced  the  i^rostate,  and  the  patient  was  out  in  a few 
days.  The  doctors  had  had  him  ready  to  die  of  kidney  trouble,  but  the  trouble 
was  all  in  the  bladder  and  prostate.  Of  course  in  all  our  treatments  we  get 
particularly  an  effect  upon  the  centers  indicated  in  the  spine,  viz.:  the  fifth 
lumbar  and  the  second  lumbar,  the  centers  respectively  for  the  hypogastric- 
plexus  and  micturition.  The  treatment  there  I hardly  need  to  show  you;  it 
is  the  same  as  I have  already  shown  you  in  how  to  treat  the  spine.  There  is 
another  treatment,  thongh,  which  I have  already  shown  you,  the  treatment 
by  raising  the  bladder  bodily.  You  can  do  the  same  thing  by  having  the 
patient  stand  in  front  of  you,  bending  forward  at  right  angle,  thus  letting  the 
al)dominal  contents  drop  down  toward  the  symph^’sis,  then  by  deep  pressure 
inward  and  raising  as  the  patient  straightens  up,  you  can  raise  all  those  parts. 
I lufve  spoken  already  of  euteroptosis,  the  dropping  down  of  the  intestine 
shall  speak  presently  of  the  prolapsus  of  the  uterus  and  all  those  things  that 
allow  a lengthening  and  a relaxation  of  the  ligaments  which  bind  these  abdom- 
inal contents  to  the  walls.  Anything  which  allows  a relaxation,  of  course 
brings  down  those  structures,  and  the  Osteopath  argues  that  there  is  too  little 
life  there.  Now,  how  does  he  go  about  to  replace  those  things?  Should  he 
simply  push  them  into  place,  they  would  not  stay — they  must  be  held  there. 
Hence,  the  importance  of  our  vvork  along  the  spine,  stimulating  the  nerve  force 
and  life  to  the  omenta  which  are  holding  these  abdominal  contents  in  place,  so 
as  to  regain  their  tonicity.  Never  forget  that  it  will  not  do  to  replace  a pro- 
lapsed uterus  or  replace  intestines  which  are  displaced  by  reason  of  enterotosis, 
unless  at  the  same  time  you  include  the  work  along  the  spine  ; that  we  work 
with  the  idea  of  stimulating  the  life  of  the  ligaments  and  making  them  tense 
again.  In  fact,  we  should  always  have  that  in  view,  particularly  we  should  be 
careful  to  stimulate  or  inhibit  the  nerve  force  to  the  part  in  trouble.  We  would 
also  work  deeply  in  this  manner  here  over  the  internal  iliacs.  That  is  one  of 
the  treatments  for  the  bladder  also.  We  thus  stimulate  the  blood  supply  ami 
direct  it  more  particularly  to  the  part  affected,  by  reason  of  the  tendency  tow- 
ard the  normal,  and  that  treatment  is  very  effective  in  such  troubles.  Of  course 
in  retention  of  urine  you  will  always  suspect  some  stricture.  You  may  have 
an  enlargement  of  the  prostate  or  some  trouble  of  the  sphincter  of  the  bladder. 
You  will  Ihid  also  that  the  quantity  of  urine  varies — after  very  long  reading  by 


184 


a person  who  is  not  used  to  reading  much,  the  amount  of  urine  will  be  in- 
creased, and  after  hysteria  and  various  troubles,  the  amount  of  urine  is  greatly 
increased.  There  is  a motion  emplo3’ed  largely  by  Mrs.  Patterson  for  raising 
both  the  bladder  and  the  uterus.  She  has  the  patient  flex  the  thighs,  then, 
directing  the  patient  to  hold  the  knees  together,  you  push  them  apart.  In  other 
words,  you  work  against  the  resistance  of  the  flexed  thighs.  In  that  way  the 
psoas  muscles  will  contract  and  the  idea  is  that  as  you  push  them  out  the  blad- 
der will  be  raised ; having  done  that  you  try  just  the  opposite  and  tell  the 
patient  to  hold  the  knees  apart  and  j'ou  draw  them  together.  Mrs.  Patterson 
employs  that  method  of  treatment  very  frequently  and  has  had  verj’  good  suc- 
cess in  female  troubles  in  that  way.  It  affects  both  the  bladder  and  uterus. 

We  should  next  direct  our  attention  to  the  ovaries.  They  are  found  an 
inch  and  a half  inward  from  the  anterior  superior  spines  of  the  ilia.  It  is  said 
the}'  cannot  be  examined  by  physical  means,  that  is,  you  cannot  find  them  by 
simply  feeling  over  the  flesh  where  they  should  be,  and  it  is  only  when  tender 
or  when  enlarged  that  you  will  be  able  to  make  out  by  physical  examination 
the  location  of  the  ovaries.  However,  when  inflamed,  as  they  very  frequently 
are,  the  intense  tenderness  there  about  an  inch  and  a half  interior  to  the  anter- 
ior superior  spine  would  indicate  their  site.  Also  when  inflamed  they  frequent- 
ly cause  a swelling  there  and  you  will  be  able  to  find  their  location.  The  ovary' 
is  also  frequently  the  seat  of  a tumor,  and  the  tumor  may  become  very  large, 
and  then  not  only  palpation,  but  inspection,  will  reveal  the  seat  of  the  trouble. 
Our  treatment  for  the  ovaries  is  through  the  lumbar  region,  as  you  know.  The 
centers  given  by  Howell’s  Text  Book  for  the  internal  genitals  are  along  the 
lumbar  region  from  the  second  to  the  fifth ; that  is,  vaso-motor  fibers  of  both 
kinds  run  to  the  internal  genital  organs.  We  should  also  examine  carefully 
the  sacro  iliac  region  and  the  lower  dorsal.  The  center  for  the  blood  supply' 
for  the  ovary  is  between  the  tenth  and  eleventh  dorsal,  and  you  should  look  all 
the  way  from  the  ninth  to  the  twelfth  dorsal  particularly  to  see  whether  or  not 
there  is  a lesion  affecting  the  ovaries.  We  work  upon  the  eleventh  dorsal,  re- 
storing it  to  normal  when  it  has  been  misplaced,  both  in  cases  of  profuse  men- 
struation and  in  scant  menstrual  flow.  That  seems  to  be  the  particular  center 
since  it  has  control  of  the  blood  supply  to  the  ovary.  Also,  as  y'ou  know,  the 
spermatic  artery  in  the  male,  becoming  the  ovarian  in  the  female,  arises  about 
opposite  the  second  lumbar  vertebra,  that  is,  a little  above  the  umbilicus,  and 
by  working  in  deeply,  trying  to  get  as  far  as  possible  in  under  the  transverse 
colon  and  working  on  down  in  the  direction  of  that  artery,  down  as  far  as  the 
ovary,  you  vvill  be  able  to  stimulate  the  blood-flow,  and  then  by  working  back- 
ward in  the  same  direction  you  stimulate  the  venous  flow;  also  vvorking  over  the 
iitering  blood  supply',  because  these  vessels  anastomose  a good  deal,  and  you 
thus  stimulate  the  entire  blood  supply.  Of  course  the  ovaries  are  closely  con- 
cerned with  menstruation  and  it  will  be  worth  your  while  to  bear  in  mind  that 


185 


they  act  alternately,  one  will  ovulate  one  mouth  and  then  not  again  until  the 
second  month.  So  if  you  have  a trouble  recurring  every  second  month  j-ou 
will  be  able  to.  calculate  that  the  trouble  is  in  one  ovary  or  the  other,  and  your 
further  examination  will  indicate  to  you  which  Is  the  ovary  affected.  In  eases 
of  obesity  where  the  patient  is  extremely  large,  eases  are  on  record  where  the 
accumulation  of  fat  has  acted  to  crowd  the  ovary,  hence  the  menstrual  flow  did 
not  occur  and  the  ovaries  were  atrophied.  It  may  act  in  a mechanical  way  and 
separate  the  Fallopian  tube  from  the  ovary  so  that  the  Fallopian  tube  cannot 
take  up  the  ovum  wuen  discharged.  So  that  if  you  have  such  a case  of  men- 
strual trouble  where  the  patient  is  extremely  large  and  obese,  then  you  will 
bear  in  mind  that  the  obese  condition  itself  may  have  some  effect  in  causing 
the  trouble.  Of  course  the  ovary,  as  it  is  situated  in  the  broad  ligament,  is 
drawn  down  in  any  prolapsus  of  the  uterus  and  will  be  implicated  in  many 
troubles  of  that  kind.  As  for  treatment,  it  is  especially  along  the  lumbar  re- 
gion and  also  at  the  centers  designated,  the  eleventh  dorsal,  not  forgetting  the 
fifth  lumbar,  which  is  the  center  for  the  hypogastric  plexus,  through  which  we 
get  the  pelvic  plexuses  which  have  to  do  with  the  life  of  the  ovary. 

Q.  In  that  case  of  paralysis  you  spoke  of  caused  by  the  grippe,  what  was 
affected ! 

A.  The  whole  spinal  life  was  affected.  I have  seen  cases  where  the  grippe 
was  the  only  cause  apparently  and  the  whole  muscular  life  along  the  spine  was 
diminished. 

Q.  Do  you  think  that  can  be  corrected  by  treatment? 

A.  Yes,  sir;  1 think  we  can  secure  good  results. 

Q.  Does  that  also  include  the  ligaments  along  the  spine? 

A.  Yes,  sir ; that  is  the  main  trouble.  The  ligaments  are  contracted, 
shutting  off  the  nerve  force. 


LECTUEE  XXYII. 

At  the  last  lecture  I spoke  of  the  examination  and  treatment  of  the  pelvic- 
viscera.  I shall  continue  that  subject  to-day,  concluding  the  examination 
and  treatment  of  the  pehfls  and  its  contents,  and  taking  up  the  osteopathic 
treatment  of  the  limbs;  I shall  then  have  gone  over  the  whole  body. 

I.  Examination  and  Treatment  of  the  Pelvic  Viscera. — Con- 
tinued.— The  next  organ  for  us  to  consider  is  the  uterus.  I might  say  in 
passing  that  female  diseases  are  among  the  most  numerous  class  of  cases  that 
we  handle,  and  are  among  those  best  handled  by  us.  A very  large  per  cent 
of  your  cases  will  be  various  female  troubles,  and  you  will  have  very  good 
success  with  them.  The  examination  of  the  ovaries  I spoke  of  at  the  last 
meeting.  Xext  to  the  ovaries  the  uterus  is  quite  as  frequently  the  seat  of 
tumors  as  elsewhere.  These  may  occur  in  any  part  of  the  organ,  and  when 


186 


these  have  enlarged  the  organ  by  their  growth,  you  can  by  the  ordinary 
methods  of  examination  find  the  trouble.  In  general,  speaking  of  troubles  of 
the  uterus,  prolapsus  is  very  common,  anteversion,  retroversion;  also  ante- 
flexion or  retroflexion,  the  bending  of  the  uterus  on  itself.  \Yhen  the  uterus 
falls,  it  may  fall  forward  and  impinge  upon  the  bladder,  and  thus  one  of  the 
symj)toms  will  be  very  frequent  micturition.  It  may  fall  backward  and  im- 
pinge upon  the  rectum,  and  you  will  have  a mechanical  cause  of  constipation; 
dragging  pain  in  the  loins  and  pain  down  the  limbs.  Frequently  it  is  asso- 
ciated with  local  headache,  which  is  generally  on  the  top  of  the  head;  it  may 
be  on  the  back  of  the  head  or  it  may  run  over  to  the  fox'ehead  or  to  one  side, 
but  its  peculiarity  seems  to  be  that  it  becomes  a local  headache.  There  are 
other  symptoms,  since  the  uterus  becoming  displaced  will  impinge  upon 
other  viscera  and  the  plexuses  of  those  viscera.  You  will  have  sympathetic 
troubles,  such  as  vomiting,  sick  stomach,  and  things  of  that  kind.  In  case 
of  any  displacement  of  the  uterus,  the  patient  is  likely  to  be  very  sick  at  the 
menstrual  period.  At  such  times  the  fact  that  the  organ  is  down  and  is  thus 
stopping  the  flow  of  blood  will  lead  to  this  condition.  I have  seen  very  pain- 
ful cases  at  the  period  relieved  immediately  by  replacing  the  uterus.  How- 
ever, that  is  not  usually  a good  plan  to  pursue  at  the  menstrual  period,  since 
the  organ  then  is  very  tender,  and  any  handling  is  liable  to  irritate  it  and  set 
up  an  inflammation  or  some  sort  of  growth,  and  you  must  always  be  extremely 
careful  in  local  treatments  of  the  uterus.  There  have  been  some  very  re- 
markable cases  instanced  of  an  enlarged  uterus.  Of  course  the  uterus  nor- 
mally enlarges  within  physiological  limits;  it  enlarges  also  from  tumor.  The 
chief  way  in  which  tumor  is  differentiated  from  the  normal  enlargement  of 
Ijregnancy,  is  that  after  a certain  time  you  can  hear  the  uterine  souffle  and 
the  foetal  heart  beat.  Also  after  the  fourth  month,  sometimes  before  and 
sometimes  later,  you  will  get  movements  of  the  uterus.  Dr.  Smith  tells  quite 
an  amusing  story  of  a lady  who  came  to  term,  she  was  perfectly  sure  that  she 
was  ready  to  be  delivered,  but  he  found  merely  gas  in  the  intestines,  a pecu- 
liar movement  of  the  gas  had  simulated  the  movement  of  a foetus,  which  had 
been  taken  for  quickening,  and  the  gas  in  every  respect  simulated  pregnancy; 
and  so  it  has  been,  you  will  find  some  remarkable  cases.  I only  speak  upon 
these  subjects  generally,  because  in  gynecology  and  obstetrics,  which  you 
will  take  up  later  elsewhere,  they  will  be  treated  fully.  Whai-  I aim  to  tell 
you  is  how  the  Osteopath  treats  the  uterus.  In  examining  the  uterus,  be- 
sides these  general  symptoms  I have  given  yon,  a local  examination  will 
usually  remove  all  doubt.  By  inserting  the  finger  into  the  vagina  you  can 
feel  at  the  upper  end  of  the  vagina,  the  uterus.  You  know  how  the  uterus 
lies  in  relation  to  the  passage  of  the  vagina — nearly  at  right  angles,  perhaps 
not  quite.  The  normal  feeling  of  the  cervix  is  described  by  the  “Old  Doctor” 
to  be  about  like  the  normal  feeling  of  the  end  of  the  nose,  that  is,  when  the 


187 


uterus  is  normal.  On  account  of  the  transverse  direction  of  the  os  you  can 
tell  whether  or  not  the  uterus  be  fallen  or  twisted.  If  you  find  that  the  os, 
instead  of  being  directed  from  side  to  side,  is  turned  at  an  angle,  yon  can 
judge  from  that  in  which  direction  the  uterus  has  been  twisted.  The  most 
common  displacement  is  said  to  be  downward  and  backward  and  to  the  left. 
Frequently  you  will  find  a sort  of  a turn  associated  with  this  displacement, 
and  that  the  nterus  lies  down  near  the  left  sacro  iliac  articulation.  If  the 
uterus  has  fallen  forward,  of  course  you  will  find  the  cervix  and  the  os  pro- 
jecting backward,  and  if  it  has  fallen  backward,  you  will  have  the  cervix  and 
os  projecting  forward,  and  you  will  be  able  to  judge  as  to  its  position.  That 
is  what  the  Osteoj^ath  ascertains  in  making  examination  per  vaginam — he 
looks  to  see  whether  or  not  the  uterus  is  in  normal  position. 

Of  course  you  know  about  the  eight  ligaments  of  the  uterus;  the  broad 
ligaments  are  the  most  useful.  They  extend  from  each  side  to  be  attached  to 
the  pelvis,  and  when  the  nterus  is  displaced  to  one  side  yon  will  find  a ten- 
derness in  the  broad  ligament  on  the  opposite  side,  readily  explained  of 
course  as  the  tension  comes  upon  the  ligament  of  the  other  side,  the  weight 
coming  on  it  as  the  uterus  falls  from  it.  That  is  one  way  in  which  we  diagnose. 
Another  point  in  examination  per  vaginam  is  to  note  the  condition  of  the 
vaginal  walls.  Of  course  in  prolapsus  the  walls  have  lost  their  tone:  they 
have  part  of  the  duty  of  sustaining  the  weight  of  the  uterus.  'When  they  are 
full  of  tone  they  will  help  to  hold  the  uterus  up,  but  if  they  are  prolapsed 
and  sunken  down  they  become  flaccid.  Frequently  you  can  give  great  relief 
in  female  troubles  by  simply  passing  the  finger  up  along  each  side,  before  and 
behind  and  at  each  side,  and  smoothing  out  these  wrinkles  which  have  gotten 
into  the  walls  of  the  vagina.  Yon  can  also  by  that  treatment  stimnlate  the 
flow  of  blood  and  stimulate  the  local  nerve  force,  and  thus  lead  to  more  life 
in  the  vagina  and  consequently  to  a better  performance  of  its  duty  of  helping 
to  hold  the  uterus  up. 

You  will  find  such  troubles  as  leucorrhea  following  the  displacement  of 
the  uterus,  since  the  nutrition  is  partly  cnt  off  from  the  walls  of  the  vagina, 
the  circulation  is  impeded  and  the  healthy  tone  does  not  exist,  consequently 
you  have  a morbid  secretion. 

The  normal  i)osition  of  the  nterus  1 siqjpose  is  known  to  yon — the  broad 
ligament  tilts  somewhat  backward  in  the  pelvis  and  the  nterus  is  tilted  for- 
ward at  the  upper  part  of  the  vaginal  passage,  so  that  yon  have  practically 
speaking  a right  angle  between  the  walls  of  the  vagina  and  the  uterus,  per- 
haps not  quite  a right  angle.  Of  course  the  uterus  normally  does  not  rise 
above  the  brim  of  the  pelvis.  I wish  to  emphasize  in  this  connection  with  I 
said  the  other  day  in  regard  to  prolapsus  of  the  uterus  and  of  the  intestine, 
that  is,  the  Osteopath  rejilaces  them,  but  does  not  expect  them  to  stay  simply 
because  he  has  replaced  them.  You  must  always  couple  local  treatment  with 


188 


treatment  along  the  spine.  I remember  a case  in  point — 1 examined  a young 
lady  in  Peoria,  she  had  had  a twist  in  the  gymnasium,  she  had  jumped  to 
catch  a cross-bar  and  had  given  herself  a jerk  and  a twist.  Along  in  the  up- 
per lumbar  region  there  was  a lesion,  I do  not  remember  now  exactly  which 
vertebrm  were  displaced,  it  was,  however,  of  the  lumbar  vertebrm,  there  was 
quite  a xjrominence  of  one  of  them.  Shortly  after  the  accident  the  young  lady 
was  troubled  with  frequent  micturition,  and  local  examination  later  revealed 
the  fact  that  the  uterus  was  down  ui)on  the  bladder.  That  case  was  treated 
at  the  front  over  the  abdomen,  over  the  iliacs,  and  along  the  sjjine,  particu- 
larly at  the  second  and  fifth  lumbar  centers,  through  which  you  can  reach  the 
uterus.  The  case  was  entirely  cured  in  two  months,  and  she  had  not  had 
local  treatment  more  than  a half  dozen  times.  So  yon  see  the  Osteopath  does 
not  depend  ujjon  simi^le  reposition,  he  dejjends  largely  upon  the  work  of 
stimulating  the  nerve  force  and  toning  up  the  blood  supply  to  give  tone  to 
these  ligaments  which  have  lost  their  tone,  and  thus  hold  the  parts  in  place. 
For  the  puiqjose  of  the  Osteopath  the  finger  answers  as  well  as  anything  for 
an  instrument.  The  first  finger  is  usually  inserted,  and  you  can  feel  the 
cervix  of  the  uterus.  The  idea  then  is  to  push  upward  in  such  a way  that 
the  organ  will  take  the  jiosition  of  being  at  a right  angle  to  the  broad  liga- 
ment, and  it  is  as  well  while  your  xiatient  is  upon  the  table  to  insert  the  fin- 
ger, reach  ux^ward  to  the  uterus,  then  have  the  patient  slip  around  and  stand 
up  and  you  can  then  push  forward.  One  of  the  best  ways  of  replacing  the 
uterus  is  to  have  the  patient  take  the  knee-chest  position — kneel  with  the 
chest  down  ux^on  the  table  or  bed,  and  then  to  XJush  the  uterus  ux>,  and  thus 
allow  the  intestines  to  fall  down  behind  and  over  the  uterus  and  hold  it  in 
X>lace.  The  “Old  Doctor”  has  invented  an  instrument  which  is  very  useful 
also  in  reposition.  It  is  a wire,  curved  with  a handle.  The  finger  of  the 
operator  is  slixjpcd  in  with  the  instrument  lying  in  the  opening  between  the 
two  Avires,  and  then  the  x^oint  of  the  instrument  is  placed  either  behind  or  in 
front  of  the  os,  depending  ux>on  the  position  of  the  organ,  whether  it  has 
fallen  forward  or  backward.  Then  with  the  x^oint  of  the  instrument  back  and 
the  finger  in  front,  or  vice  versa,  you  can  Avork  the  organ  as  you  wish.  Also 
you  can  by  Avorking  uxion  the  abdomen  aid  to  lift  the  parts.  I have  already 
shown  you  how  that  is  done.  That  is,  you  raise  it  with  the  patient  ux>on  the 
back  as  I have  shoAvn  you,  or  Avith  the  patient  upon  the  side,  or  standing  bent 
at  a right  angle,  and  you,  pushing  the  fingers  in  deex)ly  over  the  abdomen, 
raise  bodily  the  contents.  It  is  also  a good  idea  to  have  the  x^atient  x^i'actice 
taking  the  knee  and  chest  x^osition  and  simx^ly  dilating  the  x>assage,  the  at- 
mospheric xAi’essure  Avill  sometimes  be  sufficient  to  cause  the  uterus  to  take  its 
place;  also  the  motion  I shoAved  you  at  the  last  meeting,  having  the  patient 
lie  upon  the  back  and  flex  the  thighs,  thus  stretching  the  x^soas  muscles,  and 
X)ush  the  legs  ax)art  while  holding  them  together,  and  draAv  the  legs  together 
Avhile  they  are  held  apart. 


189 


Treat  especially  the  centers  mentioned,  that  is,  the  second,  which  is  the 
blood  supply  for  the  uterus,  and  the  fifth,  which  is  the  center  through  which 
we  reach  the  hypogastric  plexus,  and  all  along  the  lumbar  and  sacral  region  in 
general,  but  do  not  fall  into  the  error  of  thinking  the  trouble  is  always  there, 
because  the  lesion  may  be  above  or  below  the  center  at  which  you  would  natur- 
ally expect  to  find  the  trouble. 

I have  already  mentioned  the  point  that  you  should  stimulate  the  coccygeus 
muscle  through  the  sacral  plexus,  and  thus  cause  it  to  contract  and  aid  in  rais- 
ing the  contents  of  pelvis.  You  can  also  stimulate  the  ronnd  ligaments  which 
pass  over  the  pubic  arch  just  external  to  the  symphysis ; you  can  find 
them  both  by  the  feeling  and  by  the  sensitiveness,  because  when  you  impinge 
upon  them  you  will  always  have  an  expression  of  pain.  Stimulation  there  will 
help  to  draw  up  the  uterus ; all  these  things  help  a good  deal.  Stimulation  at 
the  second  lumbar  is  used  to  cause  contraction  of  the  longitudinal  fibers  of  the 
uterus,  while  stimulation  of  the  clitoris  and  round  ligaments  is  used  to  cause 
contraction  of  the  circular  fibres  of  the  uterus.  Consequently,  we  inhibit  over  the 
clitoris  and  round  ligaments  to  cause  them  to  relax  and  thus  relax  the  circular 
muscular  fibres  of  the  uterus.  Thai  is  one  of  the  most  important  points  in 
Osteopathic  obsteterics. 

In  young  females  and  in  pregnant  women  it  is  advised  never  to  give  an 
internal  treatment.  Mrs.  Patterson  says  that  remarkably  young  children  are 
sometimes  suffering  from  prolapsus,  and  mentions  a case  in  which  the  patient 
was  uot  over  two  years  old,  but  the  case  was  entirely  cured  by  external  treat- 
ment. Should  you  be  treating  a case  for  other  troubles  in  which  the  patient  is 
pregnant,  carefully  avoid  the  ninth  and  eleventh  dorsal  and  the  second  and 
fifth  lumbar,  in  fact,  the  whole  lumbar  region. 

Dr.  Bolles  has  mentioned  a point  to  me  which  is  extremely  interesting  and 
I think  extremely  important  also.  In  a case  in  which  there  had  been  abortion 
and  the  mother  had  kept  wasting  from  the  uterus,  a discharge  of  matter  and 
flow  of  blood,  he  directed  her  to  rub  the  nipples  each  morning  with  vaseline, 
and  thus  to  stimulate  as  far  as  possible  the  normal  irritation  made  by  the  suck 
ling  child.  He  was  thus  acting  in  accordance  with  nature,  and  the  discharge 
ceased.  In  another  case  he  followed  the  same  rule,  where  the  woman  was  in 
difficulty,  the  pregnancy  was  about  three  mouths  along,  and  the  indications 
were  that  the  foetus  had  been  dead  for  some  days.  The  nipples  were  stimu- 
lated, which  caused  contraction  of  the  uterus,  and  the  woman  was  delivered  of 
a still-born  child.  There  is  a very  close  connection  between  the  nerves  of  the 
breast  and  of  the  uterus.  It  is  a very  good  point  in  flooding — profuse  menstu- 
ration  or  in  flooding  after  child-birth,  or  in  pos-partum  hemorrhage,  which  is 
a very  serious  thing,  to  give  a quick  jerk  at  the  mons  veneris,  thus  causing 
pain  and  causing  a contraction  ; that  will  usually  stop  the  flooding.  I knew 
of  a case  uot  many  months  ago  iu  which  the  flooding  was  persistent,  and  lasted 


190 


for  some  time.  I sent  word  to  the  patient  to  try  that  treatment  that  I have 
described,  and  the  flooding  ceased  immediately.  Also  in  ease  of  post-partum 
hemorrhage  the  -‘Old  Doctor”  says- you  should  simply  insert  the  fingers  and 
press  upward  against  the  os.  He  presses  up  and  inward  to  smooth  out  any 
obstruction  which  may  cause  the  trouble  ; of  eoui’se  there  is  some  obstruction 
there  which  is  hiudering  the  proper  flow  of  the  blood  and  so  causing  the  hem- 
orrhage. and  simply  that  pressing  up  allows  the  blood  vessels  to  resume  their 
normal  relations  and  the  hemorrhage  to  be  stopped.  Of  course  you  under- 
stand when  you  come  to  treat  uterine  troubles,  it  is  a subject  for  the  specialist, 
and  you  will  get  this  subject  fully  treated  in  gynecology  and  obsteterics.  I 
cannot  do  more  than  simply  mention  to  you  the  usual  treeatmeut ; this  will 
also  be  the  case  later  in  this  lecture  when  I will  take  up  the  subject  of  disloca- 
tions, you  will  get  them  more  fully  in  surgery,  but  I will  give  you  the  usual 
Osteopathic  tratment  for  them. 

In  examination  per  rectum,  which  is  frequently  resorted  to  by  the  Osteo- 
path in  the  female,  if  you  will  at  the  same  time  insert  a catheter  into  the  urethra 
you  can  feel  the  urethra  along  the  anterior  wall  of  the  vagina.  Here  is  an 
important  point  which  I have  never  heard  mentioned  except  in  connection 
with  Osteopathic  practice.  If  your  vaginal  walls  are  relaxed  and  have  fallen 
in  response  to  a prolapsed  uterus,  you  may  very  likelv  get  a twist  or  an  ob- 
struction of  the  urethra  through  the  prolapsus  of  the  vaginal  walls.  There 
have  been  some  cases  of  that  here,  and  it  has  been  readily  cured  by  smoothing 
out  the  vaginal  walls  in  the  manner  I have  described  and  by  passing  a catheter 
up  the  urethra,  simply  sti’aighteniug  out  the  urethal  passage.  Besides  that 
you  will  find  in  digital  exploration  of  the  rectum  the  grip  of  the  external 
sphincter,  and  you  will  be  able  to  judge,  by  practice  whether  or  not  it  is  nor- 
mal. The  normal  grasp  of  the  external  sphincter  is  extremely  powerful,  and  of 
course  in  all  these  internal  treatments  you  should  insert  the  finger  only  after  it 
has  been  well  oiled  with  vaseline,  soapsuds  or  something  of  that  kind.  You 
will  have  no  diifieulty  in  inserting  the  finger  into  the  rectum ; the  palm  should 
be  turned  toward  the  coccyx,  and  the  finger  inserted  with  its  palm  toward  the 
coccyx,  and  may  then  be  turned;  the  patient  may  be  on  the  left  side,  or  may 
be  stooping  bent  over  the  table.  You  will  also  in  your  practice,  uo  doubt, 
come  across  cases  of  prolapsed  rectum,  the  gut  may  be  prolapsed  and  be  folded 
upon  itself  in  just  the  way  the  vagina  prolapses.  In  Chicago  I had  a case  in 
which  the  patient  came  in  in  great  pain,  there  nad  been  rectal  prolapsus,  and 
there  was  a great  tenesmus — a feeling  of  wanting  to  go  to  stool  continually. 
It  was  extremely  painful  and  the  patient  was  able  to  walk  only  with  great  diffi- 
culty. I surmised  at  once  that  there  was  prolapsus,  and  I inserted  the  finger 
and  crowded  the  walls  of  the  rectum  upward  all  the  way  around.  I was  able 
to  relieve  the  case  and  he  had  no  trouble  for  some  time  afterward.  In  such  a 
case  you  must  adopt  the  method  of  treating  over  the  spine  to  stimulate  the 
nerve  force  and  blood  supply  to  that  part,  and  thus  give  permanent  relief. 


101 


In  the  male,  you  will  lind,  after  inserting  the  finger  for  about  two  inches 
and  turning  it  forward,  the  prostate  gland.  It  is  said  by  some  authorities  that 
tlie  prostate  gland  is  almost  universally  enlarged  in  men  over  forty  years  of 
age.  The  enlargement  of  the  prostate  is  frequently  the  cause  of  stricture  of  the 
urethra.  You  will  find  the  lateral  lobes  of  the  gland  enlarged  or  the  cen- 
tral lobe  may  be  enlarged.  Should  the  lateral  lobes  be  enlarged  there  may 
not  be  murh  difficulty,  but  if  the  central  lobe  is  enlarged  you  are  very  apt  to 
have  stricture  of  the  urethra.  All  of  these  internal  treatments  should  be  re- 
sorted to  only  in  case  of  necessity;  you  should  not  treat  internally  very  fre- 
quently, not  more  than  once  a week,  and  sometimes  not  more  than  once  in  two 
weeks  or  a month.  Be  very  careful  in  treating  internally,  as  you  may  irritate 
the  internal  parts.  When  the  prostate  is  enlarged  it  may  set  up  considerable 
irritation,  and  curing  that  may  be  the  only  way  of  curing  certain  genital 
troubles  in  the  male  The  prostate  is  very  easily  reduced,  you  can  reduce  it 
in  half  a dozen  treatments,  treating  once  a week  or  once  in  two  weeks. 

Q.  Is  it  reduced  by  local  treatment? 

A.  By  local  treatments.  Of  course  you  must  couple  with  that  treatment 
over  the  internal  iliacs  to  tone  up  the  blood  supply. 

II.  Osteopathic  Treatment  of  the  Limbs  ; In  consideration  of  the  arm, 
the  ball  and  socket  joirt  is  the  one  most  likely  to  be  dislocated.  First  I will 
describe  the  ways  in  which  this  dislocation  may  o«cur:  The  dislocation  of  the 

humerus  may  be  downward  in  the  axilla,  it  may  be  backward  upon  the  back  of 
the  scapula,  or  in  front  under  the  clavicle,  or  it  may  be  slightly  upward,  called 
a partial  dislocation,  against  the  coracoid  process.  Now,  the  treatment  for 
any  of  these  is  practically  the  same.  One  good  way  adopted  by  the  practice  is 
to  put  the  knee  under  the  axilla  firmly,  of  course  you  would  have  an  assistant 
holding  against  the  patient  to  exert  counter  pressure.  We  would  then  presr 
the  arm  down  strongly  in  this  way,  and  out,  and  thus  spread  the  joint,  brings 
ing  pressure  upon  the  contracted  muscles  and  upon  the  ligaments,  and  they 
will  draw  the  bone  down  into  place.  Another  way  is  when  the  patient  is  lying 
upon  the  table,  simply  to  place  the  foot  in  the  axilla  in  this  way.  and  you  can 
get  a powerful  leverage,  as  you  see,  and  you  can  force  the  arm  out  into  its 
socket.  I do  not  know  just  how  frequent  the  dislocation  of  the  shoulder  is  in 
practice,  but  I do  know  that  in  gymnasium  practice  the  shoulder  is  very  fre. 
quently  dislocated  and  set  by  a move  on  the  rings,  without  harm.  This  joint  is 
usually  set  without  difficulty ; of  course  it  must  be  set  very  soon  after  dislo- 
cation. 

In  dislocation  of  the  elbow,  there  are  five  different  displacements.  Both 
bones  may  be  dislocated  backward,  both  bones  may  be  dislocated  internally  or 
externally,  the  ulna  may  be  dislocated  backward,  or  the  radius  may  be  dislo- 
cated forward  into  the  hollow  on  the  front  of  the  humerus,  or  it  may  rarelv  lie 
dislocated  backward.  One  method  described  is  to  place  the  knee  in  the  bend 


192 


of  the  arm,  and  then  by  having  your  assistant  exert  counter  traction  above  the 
elbow,  you  can  spring  the  arm  down  strongly  in  this  way.  That  will  do  for  the 
first  three.  When  you  have  thus  exerted  considerable  tension,  enough  to  over- 
come the  contraction  of  the  muscles,  the  bones  will  slip  into  their  places.  When 
the  radius  is  dislocated  forward,  of  course  that  would  draw  the  hand  back,  and 
by  turning  the  hand  toward  the  supine  or  half  supine  and  exerting  traction 
dowuiward  and  outward  in  such  a way  as  to  pull  the  head  of  the  radius  down 
into  position,  you  will  be  able  to  work  it  into  place. 

In  dislocations  of  the  wrist  both  bones  maybe  out  of  place,  the  radius  may 
be  forward  or  the  ulna  backward,  and  in  all  those  eases  simple  extension  is  re- 
quired ; you  have  your  assistant  fix  the  elbow  and  then  you  exert  powerful 
traction  upon  the  parts  until  they  have  been  drawn  into  place. 

In  dislocation  of  the  fingers  it  is  said  dislocation  is  usually  between  the 
first  and  second  phalanges,  and  there,  also,  simple  extension  is  required,  draw- 
ing straight  upon  the  finger  until  the  bone  is  slipped  back  int  > place.  Dr.  Har- 
ry Still  says,  in  his  own  peculiar  way,  that  if  a bone  is  out  all  you  have  to  do  is 
to  move  it  around  enough  and  it  will  want  to  slip  back  into  place.  As  to  the 
usual  way  of  treating  the  arm,  you  have  seen  that  we  frequently  use  it  as  a 
lever.  In  some  cases,  as  for  instance  in  articular  rheumatism,  we  work  with 
the  idea  of  spreading  the  joint  and  allowing  the  blood  and  nerve  force  to  be 
freed  about  the  joint  and  especially  allowing  the  inflow  of  the  blood,  the  stimu- 
lation of  the  blood  flow  thus  removing  the  deposit  in  the  joint.  You  can  read- 
ily stretch  the  joint  hy  doubling  the  hand  and  putting  it  under  the  axilla  and 
then  pressing  the  arm  in  against  the  side.  That,  of  course,  will  draw  the  shoul 
der  down,  and  I have  had  some  very  good  success  in  relieving  cases  of  articular 
rheumatism  in  that  way.  In  spreading  the  joint  you  can  also  stimulate.  Place 
your  hand  upon  ihe  front  of  the  elbow  and  then  bend  the  arm  strongly  over 
the  hand ; that  will  spring  the  joint ; and  also  by  turning  it  out  at  a right  angle, 
you  know  how  the  olecranon  process  catches  at  the  back  of  the  humerus,  by 
bending  the  arm  at  a right  angle  so  that  they  will  catch  you  can  exert  pressure 
in  that  way  to  spread  the  joint.  Also  you  can  stimulate  the  flow  of  blood 
down  the  arm  by  getting  a certain  twisting  motion  in  this  way.  That  is  one  of 
Dr.  Hildreth’s  movements.  I have  bold  of  the  arm  here  and  I am  moving  the 
head  of  the  humerus  in  the  socket.  I twist  it  in  that  way  without  exerting 
much  force.  I might  speak  here  of  the  fact  that  you  can  impinge  upon  the 
nerves  of  the  inner  side  of  the  arm,  the  branches  of  the  brachial  plexus  running- 
down  there,  and  the  axillary  artery.  In  general  if  you  impinge  upon  an  artery, 
press  it  toward  the  bone ; do  not  press  it  toward  the  muscle.  You  will  find  in 
your  practice  that  these  nerves  become  paralyzed  by  the  use  of  a crutch,  setting- 
up crutch  paralysis ; and  that  is  a point  which  it  is  well  to  take  into  considera- 
tion. Also  we  have  found  in  our  practice  that  something  will  catch  here  at  the 
anterior  part  of  the  shoulder  ; whether  it  is  deltoid  fibers  under  the  coracoid 


193 


process  or  whether  it  is  a simple  binding  of  the  ligaments  drawing  the  head  of 
the  humerus  out  against  the  acromian  or  coracoid,  it  is  hard  to  say,  but  we 
frequently  find  a catch  there  which  we  can  reduce  by  drawing  the  arm  upward 
and  backward,  and  then,  when  horizontal,  draw  it  outward,  and  having  the 
fingers  in  front  over  the  process  there  you  can  free  any  obstruction  in  that  way. 
I do  not  know  just  what  catches  there,  but  I have  seen  cases  of  extremely  lame 
arms  which  could  not  be  raised  higher  than  the  head  and  could  not  be  put  be- 
hind the  back,  relieved  by  that  treatment.  Sometimes  you  will  have  such  an 
injury  as  will  cause  a contraction  of  one  of  the  heads  of  the  biceps  muscle ; you 
know  its  attachments ; by  straightening  the  arm  and  drawing  it  backward,  thus 
lengthening  the  distance  between  the  attachments  of  that  muscle,  you  bring 
tention  upon  it.  Frequently  you  will  find  that  muscle  contracted,  and  all  you 
will  need  to  do  is  to  stretch  it,  thus  inhibiting  its  nerve  force  and  thus  relaxing 
its  spasm,  ana  you  get  rid  of  the  trouble. 

In  the  treatment  of  the  legs  you  have  all  seen  the  various  motions  we  all 
go  through  with,  perhaps  you  have  not  all  appreciated  what  the  purpose  of  each 
movement  was.  When  I flex  the  thigh  above  the  thorax  and  the  leg  upon  the 
thigh  I am  stretching  the  quadriceps  extensor  muscles.  You  see  you  simply 
stretch  it  and  with  it  you  free  the  blood  supply,  the  femoral  artery  and  the  an- 
terior veins  and  the  anterior  crural  nerve.  That  is  the  purpose  of  this  motion 
which  you  see  so  frequently  employed.  Sometimes,  of  course,  we  simply  use 
this  motion  as  leverage,  having  our  hands  in  the  saero-iliac  joints ; you  know 
its  purpose  already.  You  have  thus  stretched  the  anterior  muscles  of  the  thigh ; 
you  can  stretch  the  muscles  of  the  anterior  part  of  the  leg  simply  by  pushing 
the  toe  straight  down.  That  is  a most  frequent  motion  that  the  Osteopath  uses. 
You  can  stretch  the  calf  muscles  in  just  the  opposite  way,  by  pushing  the  toe  in 
the  direction  of  the  knee;  and  yon  will  have  no  difficulty  in  pushing  it  strongly 
enough.  We  can  stretch  the  adductor  muscles  by  holding  the  leg  straight, 
standing  between  the  legs  and  separating  them.  You  can  stretch  the  external 
rotators  by  an  internal  movement  in  this  way : it  is  very  well  to  regulate  the 
force  in  this  way:  In  making  this  movement  turn  just  enough  so  that  the  patient 
turns  on  the  side  it  is  not  necessary  to  use  a great  deal  of  force ; then  turn 
the  other  way  until  you  have  turned  him  about  the  same  distance.  We  may 
also  stretch  the  muscles  on  the  back  of  the  thigh,  jmu  know  that  in  raising  the 
knee,  for  instance  against  the  chest,  you  can  only  do  it  by  bending  the  leg;  if 
you  straighten  the  leg  you  can  get  it  to  a certain  height,  and  then  you  feel  ten- 
sion upon  the  hamstring  muscles,  consequently  we  frequently  use  that  in  our 
practice.  Putting  the  heel  over  the  shoulder  of  the  operator  and  raising  the 
limb  higher  than  it  can  naturally  go,  you  see  it  cannot  naturally  go  quite  to  a 
right  angle,  you  thus  lengthen  the  distance  between  the  points  of  attachments 
of  the  muscles  on  the  back  of  the  thigh  and  you  stretch  their  tendons.  Fre- 
quently you  will  find  it  important  to  stretch  those  muscles.  I had  a case  just 


194 


the  other  day  of  this  kind,  where  the  legs  were  drawn  with  rheumatism,  the  pa- 
tient had  no  use  of  the  limbs,  they  were  considerable  drawn,  the  toes  were  turned 
in,  the  muscles  set  and  it  was  with  difficulty  that  I could  handle  them.  I simply 
brought  deep  pressure  in  Scarpa’s  triangle  on  the  anterior  crural  nerves, 
and  that  relaxed  the  anterior  muscles.  I had  another  case  in  which  was  paralysis 
of  the  lower  limb,  and  frequently  the  limb  would  jerk  when  I would  treat  it,  so 
I inhibited  the  anterior  crural  nerve  and  the  limb  would  relax  directly.  So  we 
pay  particular  attention  to  Scarpa’s  triangle  since  we  can  impinge  upon  the 
femoral  artery  and  upon  the  anterior  crural  nerve.  Also  we  treat  in  the  popliteal 
space ; we  very  frequently  knead  it  or  work  its  contents,  simply  bending  the 
knee,  putting  the  foot  of  the  patient  between  your  thighs  and  working  the  flat 
of  your  hand  in  the  popliteal  space ; you  can  thus  free  any  contraction  there 
and  can  stimulate  both  the  popliteal  nerves  and  the  blood  vessels. 

Frequently  in  cases  of  rheumatism  you  will  have  trouble  with  the  feet. 
You  cau  straighten  them  down  forward  as  I have  shown,  or  backward.  In  treat- 
ing the  feet  you  will  see  that  there  are  two  natural  arches,  one  lengthwise  of 
the  foot  and  one  crosswise  of  the  foot ; consequently  in  your  treatment  of  the 
feet  you  can  break  it  in  two  ways — you  can  spring  it  down  toward  the  toes  and 
can  work  with  both  hands  beneath  the  instep  and  spring  it  toward  the  sides. 
In  doing  that  the  pirinciple  is  that  you  stretch  the  ligaments  about  the  joints. 
You  can  stretch  the  ligaments  at  the  articulation  of  the  ankle  bj^  this  forward 
and  backward  movement  and  by  working  it  from  side  to  side.  By  breaking 
the  two  arches  of  the  foot  as  I have  shown,  you  can  relax  all  of  the  ligaments 
across  the  arch  of  the  instep.  Of  course  the  toes  can  also  be  treated  in  the 
same  way.  We  frequently  are  called  to  treat  for  corns  along  with  the  rest  of 
our  treatment,  not  that  anj"  one  pays  us  $25  for  treating  their  corns,  but  if 
they  have  something  of  that  kind  the  matter  with  them  they  always  want  you 
to  put  that  in.  When  you  are  treating  a toe,  you  know  the  vessels  run  down 
the  outside ; simply  spring  it  from  one  side  to  the  other  ; that  will  stretch  the 
‘ligaments  and  the  blood  vessels  and  stimulate  the  nerves. 

Q.  Would  that  treatment  cure  a cramp  in  the  foot? 

A.  It  would  depend  upon  the  cause,  if  the  cause  were  in  the  foot  it 
would.  You  could  very  well  cure  some  cases. 

Q.  Would  it  cure  cramps  on  the  bottom  of  the  foot? 

A.  It  would  depend  upon  where  your  obstruction  was;  it  might  be 
higher  in  the  path  very  likely.  You  would  have  no  trouble  in  curing  it  in 
the  foot;  I have  found  that  in  my  own  case,  by  simply  stretching  it.  Every 
one  naturally  does  that;  some  people  are  much  troubled  by  cramping  in  the 
feet. 

It  frequently  becomes  the  duty  of  the  Osteopath  to  stretch  the  sciatic 
nerve  thoroughly  by  stretching  in  this  way,  the  heel  of  the  patient  over  oper- 
ator’ s shoulder,  and  lengthening  the  distance  along  the  back  of  the  leg,  and 


195 


then  since  the  branches  of  the  nerve  run  on  down  over  the  planter  surface  of 
the  foot  simply  pull  down  on  the  toe  and  you  can  stretch  the  sciatic  nerve 
considerably.  Also,  in  treatment  of  sciatica  it  is  one  of  the  treatments  to 
work  the  limb  outward  in  this  manner,  thus  to  relax  the  muscles  throughout 
the  whole  course  of  the  sciatic  nerve,  or,  by  an  inward  turn,  the  pyriformis 
and  those  short  muscles,  the  external  rotators  which  may  impinge  upon  the 
nerve. 

As  to  dislocations. — Frequently  you  get  a dislocation  of  the  ankle,  the 
foot  may  be  thrown  outward,  in  which  case  you  have  an  inward  dislocation; 
or  it  may  be  the  reverse,  or  these  bones  may  be  thrown  forward  upon  the 
ankle,  in  which  case  you  have  a forwai'd  dislocation.  In  a few  cases  you  have 
a backward  dislocation.  The  movement  is  to  have  your  patient  lying  down, 
flex  the  knee  at  a right  angle,  have  your  assistant  fix  the  knee  so  that  he  can 
exert  counter-extension,  then  you  simply  stretch  and  bend  the  foot  in  the  di- 
rection in  which  it  would  go.  If  it  was  thrown  outward  stretch  it  and  bend 
it  inward,  and  vice  versa.  We  do  this  in  the  case  of  the  toes,  simple  exten- 
sion is  the  method  employed.  In  the  case  of  the  knee  the  dislocations  also 
are  four:  inward  or  outward,  forward  or  backward.  It  is  said  simple  exten- 
sion is  enough.  However,  the  Osteopath  uses  this  movement:  he  flexes  the 
knee  at  a right  angle,  and  then  reaching  in  at  the  popliteal  sj^ace  he  grasps 
both  the  internal  and  external  hamstring  tendons  and  pulls  outward  with  the 
idea  of  spreading  them,  drawing  them  away  from  the  prominences  at  the  end 
of  the  femur;  and  then  he  pulls  with  considerable  tension  and  attempts  to 
spring  the  joint  back  into  ]3lace. 

Dislocation  of  the  knee  is  rather  serious  as  it  is  especially  apt  to  be  fol- 
lowed by  inflammation. 

As  to  the  hip.  There  are  four  dislocations  described  for  the  hip.  One 
is  uj)ward  and  backward  upon  the  dorsum  of  the  ilium,  in  which  case  the  leg 
is  shortened  and  the  toes  are  turned  inward.  Another  is  backward  into  the 
sciatic  notch,  in  which  case  also  the  limb  is  shortened,  though  not  so  much, 
and  the  toes  are  turned  inward.  The  third  is  forward  into  the  obturator  for- 
amen and  is  called  the  thyroid  dislocation.  It  is  the  most  difficult  with  which 
we  have  to  deal,  and  when  such  is  the  case  the  knee  is  bent,  the  toes  point  to 
the  ground  and  may  rotate  inward  or  outward;  and  in  the  other  ease  the  head 
of  the  femur  if  forward  ui^on  the  pubic  arch  and  the  turn  of  the  toes  is  in- 
variably outward.  So  you  have  two  in  which  it  is  always  inward,  one  in 
which  it  may  be  inward  or  outward,  and  one  in  which  it  is  invariably  out- 
ward. Of  course  dislocations  when  they  are  new  are  fairly  easy  to  reduce, 
but  the  Osteopath  gets  them  almost  always  when  they  are  old.  Your  treat- 
ment must  first  be  directed  to  softening  all  the  ligaments  and  the  muscles,  re- 
moving the  unnatural  tension,  and  thus  get  the  hip  ready  to  set.  These  old 
cases  are  almost  always  slow  to  set,  though  I have  seen  some  long  standing 


19G 


cases  set  in  a few  treatments.  You  always  have  two  factors  of  great  aid  to 
you,  one  is  the  anterior  ‘‘Y”  ligament  of  the  hip  joint  and  the  other  is  the 
action  of  the  small  muscles,  the  pyriformis,  obturator  internus  and  externus, 
the  two  gemelli,  and  the  quadratus  femoris.  They  are  attached  in  such  a waj^ 
as  to  draw  on  the  great  trochanter.  When  it  is  up,  they  are  below,  conse- 
quently they  are  of  great  importance  to  us  in  setting  a hip.  If  the  hip  is  up 
and  back,  you  simply  Hex  the  thigh  still  more,  turn  it  inward  strongly  until 
you  get  the  tension  of  those  muscles,  and  then  throw  it  outward,  and  get  the 
head  of  the  femur  to  travel  just  over  the  edge  of  the  ascetabulum.  That  looks 
very  easy,  but  I will  assure  you  it  is  not.  When  it  is  dislocated  backward 
into  the  sciatic  notch,  the  idea  is  to  flex  the  thigh,  work  the  knee  inward  to 
disengage  the  head  of  the  femur  from  the  notch,  and  then  work  it  upward  and 
forward  in  this  way,  and  you  get  the  head  of  the  femur  drawn  toward  the  as- 
cetabulum. When  the  dislocation  is  forward  into  the  obturator  foramen  you 
are  usually  in  difficulty.  The  motion  described  for  that  is  to  flex  the  knee 
and  to  rotate  it  inward,  using  the  attachment  of  the  ‘‘Y”  ligament  as  a fulcrum 
against  which  the  limb  works.  Flex  the  thigh  and  work  the  head  of  the  fe- 
mur inward  or  toward  the  cotyloid  notch.  In  the  fourth  dislocation,  where 
the  head  of  the  femur  is  over  the  brim  of  the  pelvs,  considerable  tension  is 
exerted  backward,  long  enough  to  stretch  these  ligaments,  and  then  try  to 
lift  the  head  of  the  femur  over  and  across. 

In  diagnosing  the  hip  dislocations  you  frequently  find  it  very  difficult. 
If  your  dislocation  is  backwai’d  into  the  sciatic  notch,  you  limb  will  be  a lit- 
tle shorter,  the  toes  will  be  turned  in,  and  when  the  patient  sits  up  you  have 
a shorter  limb.  While  if  it  is  forward  it  always  lengthens  the  limb  for  the 
patient  to  sit  up.  Of  course,  as  I have  said,  these  things  get  out  and  stay 
out  for  a great  length  of  time,  and  we  have  a great  deal  of  trouble  in  getting 
them  back,  and  I believe  of  all  the  hard  dislocations,  the  most  difficult  to 
treat  is  the  one  into  the  obturator. 


LECTURE  XXVIII. 

There  are  two  or  three  points  to  which  I neglected  to  call  your  attention 
at  the  last  time.  I mentioned  treating  the  prostate  gland,  but  did  not  show 
you  hov/  to  treat  it.  You  know  how  to  find  the  gland,  and  working  down 
across  it  on  each  side  with  a fairly  firm  pressure,  just  to  stimulate  the  fiow  of 
blood  through  it,  is  the  motion  employed. 

Also  as  to  the  saphenous  opening,  we  treat  that  by  stretching  the  thigh 
which  has  been  flexed  outwards;  that  will  enable  you  to  stretch  the  muscles 
about  that  opening,  then  by  rotating  the  limb  inward  and  relaxing  the  mus- 
cles, you  can  work  your  fingers  in  at  the  opening,  you  stretch  the  muscles  about 
it  and  free  the  opening. 


197 


Tenesmus  in  the  lower  bowel  occurs  frequently  in  diarrhea  and  in  other 
troubles.  This  can  be  relieved  by  working  over  the  sacrum,  especially  over 
the  muscles  to  stimulate  and  thus  cause  a contraction  of  the  sphincter  and  a re- 
lief of  the  feeling  of  tenesmus. 

Frequently  after  parturition  the  disease  known  as  milk  leg,  or  phlegmasia 
dolens,  occurs,  and  is  probably  due  to  a contraction  of  some  of  the  short  mus- 
cles, probably  the  pyriformis ; it  sometimes  happens  that  the  hip  has  been 
thrown  out  in  the  efforts  of  parturition.  Always  after  attending  such  a case 
the  hip  should  be  turned  to  see  that  it  is  properly  in  place,  and  see  that  the 
muscles  are  properly  stretched.  The  saphenous  veins  should  be  treated  also. 

Q.  How  would  you  treat  for  fainting! 

A.  By  the  common  methods  employed — anything  to  lower  the  head  ; some 
people,  for  instance,  when  they  know  they  are  going  to  faint,  as  some  do,  will 
drop  over  the  back  of  a chair,  with  the  head  down,  and  that  will  stop  it.  When 
such  has  occurred,  get  the  head  of  the  patient  lower  than  the  feet,  you  can  then 
have  him  hang  his  head  over  the  end  of  the  table  at  the  foot ; or  you  may  shock 
him,  pull  the  hair,  or  a simple  slap  will  draw  the  blood  to  the  head  when  it  is 
exhausted. 

Q.  I have  a case  in  mind  in  which  bleeding  of  the  nose  occurred  and  last- 
ed four  or  five  hours  before  it  was  stopped,  and  the  patient  finally  died.  What 
would  be  the  treatment? 

A.  To  check  epistaxis  or  bleeding  from  the  nose  we  work  in  the  superior 
cervical  region,  stimulating;  that  is  frequently  of  use.  Or  you  may  hold  the 
facial  artery  where  it  crosses  the  angle  of  the  jaw,  or  hold  the  nasal  branches 
just  here  at  the  inner  eanthuS  of  the  eye.  Hold  them  strongly.  That  is  the 
usual  treatment,  particularly  the  stimulation  in  the  cervical  region. 

Q.  In  case  of  a lady  whose  babe  is  about  fifteen  months  old ; since  the 
birth  of  her  child  she  has  liad  an  extremely  sore  mouth ; the  condition  of  the 
alimentary  canal  has  been  such  that  she  could  not  eat  but  a ver}’  light  diet ; 
diarrhea  all  the  time,  and  a gradual  wasting  away  of  her  strength  and  muscular 
system  until  she  is  almost  a skeleton.  What  could  be  done  Osteopathically  ? 

A.  What  we  would  describe  as  a general  treatment  should  be  given  ; a 
general  spinal  treatment  to  tone  up  the  nervous  system  particularh',  reaching 
especially  the  centers  for  the  bowels,  the  splanchnics,  and  reaching  also  the 
kidneys  and  the  liver,  toning  up  the  secretory  and  excretory  organs,  and  keep- 
ing the  system  in  as  good  a condition  as  possible. 

Q.  It  IS  the  disease  known  among  the  medical  profession  as  nurse’s  sore 
mouth:  there  is  also  uterine  trouble. 

A.  You  wruld  have  to  look  after  that  also.  The  trouble  is  probably  of 
nervous  origin. 

Q.  In  the  case  of  a person  taking  a hard  cold,  or  the  disease  known  as  la 
grippe,  how  would  you  treat? 


198 


A.  I would  give  a strung  stimulating  treatment.  That  is  a thing  that  is 
very  important.  I have  already  spoken  of  the  effects  of  lagrippe  several  times, 
and  I have  found  the  most  serious  results  following  it  after  a long  period  of 
time.  Have  the  patient  on  the  face  for  the  first.  This  treatment  will  also 
apply  to  what  is  called  a bad  cold,  and  I have  had  some  excellent  results  in 
treating  bad  colds,  and  you  can  usually  cure  them.  Use  this  general  treatment. 
You  know  the  purpose  of  the  treatment — to  relax  first  all  the  muscles.  With 
the  condition  brought  about  by  la  grippe  there  is  usually  a painful  aching  of 
the  back,  especially  along  the  lumbar  region.  I then  have  the  patient  on  the 
side,  and  having  loosened  the  muscles  as  shown,  I would  spring  the  spine  all 
along  bj'  working  underneath ; you  know  the  various  motions.  Y"oii  can  separ- 
ate the  pelvis  and  the  shoulder  by  putting  your  two  arms  between  them  and 
springing  the  spine.  Then  for  this  backache  in  the  lumbar  region,  I would  go 
particularly  to  the  fifth  lumbar,  having  first  loosened  all  along  the  lumbar 
region  and  springing  the  spine  in  the  good  old  Osteopathic  way.  The  ache 
there  is  probably  caused  by  the  tension  of  the  ligaments,  and  while  we  usually 
use  an  inhibiting  motion  to  free  one  from  an  ache  or  pain,  it  depends  upon  what 
it  is  caused  by.  If  it  is  caused  by  the  contraction,  as  it  probably  is  in  such  a 
case,  the  relaxation  of  the  ligaments  should  do  the  work.  I would  then  treat 
for  the  kidneys  with  the  patient  on  the  back  ; reach  underneath  and  stimulate 
along  the  region  of  the  lower  splanehnles  and  upper  lumbar.  I would  also  in 
that  case  treat  the  liver  and  the  bowels.  Give  the  neck  a thorough  treatment ; 
I have  already  explained  all  these  things  in  detail  in  going  over  the  parts  of  the 
body.  Of  course  the  neck  is  a part  of  the  spine  and  you  must  be  particular  in 
wmtching  there  to  see  that  this  contracture  of  the  deep  muscles  does  not  affect 
important  nerves,  as  it  may  very  readily  do.  Use  the  motions  given  ; first  relax 
all  the  muscles,  then  work  deeper  and  spring  the  neck  to  relax  the  ligaments. 
Of  course  you  can  work  from  side  to  side  in  this  way,  and  before  completing 
the  operation  I would  give  the  straight  pull  as  you  see  here,  and  the  bend  of 
the  neck,  enough  to  raise  the  patient’s  head  and  shoulders  from  the  table. 
That  motion,  of  course,  will  give  a stretching  motion  all  along  the  spine.  Then 
I would  free  all  about  the  head  and  face,  the  points  of  the  fifth  nerve,  those 
places  at  which  you  know  how  to  reach  it.  I would  free  all  of  the  parts  about 
the  face.  To  free  the  nose,  press  firmly  upon  the  forehead,  spring  the  jaw 
down,  and  work  thoroughly  at  the  styloid  processes.  It  would  not  hurt  to 
work  the  arms  and  lower  limbs,  in  fact,  go  all  over  the  system  to  loosen  any 
structure,  either  muscle  or  ligament,  which  may  be  contracted  by  the  effects  of 
la  grippe. 

Q.  What  would  you  consider  a few  of  the  most  essential  points  in  con- 
sideration when  a patient  first  comes  to  see  you'? 

A.  That  is  a very  good  question,  I think,  because  it  involves  the  question 
of  how  to  start  about  an  examination.  1 would  first  take  the  pulse;  it  is  my 


199 


habit  to  do  so,  I do  uot  know  that  it  is  necessary  always ; others.  I believe,  do 
not  do  it,  but  the  pulse  is  always  considered  an  indication  in  diseases.  I would 
then  go  to  the  spine  and  e.vainine  it  thoroughly,  but  of  course  I would  be  ques- 
tioning them  as  I went  concerning  all  the  symptoms.  In  fact,  before  taking 
the  pulse  I would  ask  them  all  about  the  trouble ; I would  get  the  subjective 
symptoms. 

Q.  Do  you  think  the  history  of  the  case  is  essential,  then? 

A.  Yes,  sir,  it  is. 

Q.  Please  give  the  treatment  lor  goitre. 

A.  For  goitre  we  would  give  essentially  neck  treatment ; I will  not  need 
to  show  it  to  you.  Frequently  goitre  is  caused  by  an  obstruction  of  veins-j 
However,  I think  it  is  often  caused  by  some  impingement  upon  the  nerves  sup- 
plying the  arteries  and  veins,  consequently  you  have  an  obstruction  there.  The 
idea  would  be  to  thoroughly  relax  all  the  muscles  and  ligaments  about  the 
neck,  give  the  neck  the  straight  pull  and  the  turn  from  side  to  side,  and  bend 
it  backwards,  since  there  are  anterior  muscles  in  the  neck  wnich  you  must  take 
into  consideration.  Sometimes  it  is  those  muscles  which  are  contracted  and  are 
pressing  down  upon  the  nerves  and  vessels.  If  it  is  a hard,  encased  goitre 
with  a fibrous  capsule,  it  is  very  difficult  to  cure.  If  it  is  an  ex-ophthalmic 
goitre  you  will  have  difficulty  in  curing  it  but  the  ordinary  goitre  is  dealt  with 
with  considerable  success,  although  it  frequently  takes  considerable  time.  In 
treating  for  goitre  I vvould  also,  besides  the  general  treatment,  work  locally 
over  the  thyroid  gland,  which  you  know  is  the  gland  enlarged  in  goitre,  work 
across  it  from  side  to  side,  to  free  the  veins  there. 

Q.  How  would  you  treat  enlarged  parotid,  submaxillary  or  sublingual 
glands,  exceedingly  large  ones"? 

A.  Do  you  know  what  caused  it? 

Q.  Not  unless  it  was  scrofula. 

A.  That  was  probably  the  cause. 

Q.  Can  you  cure  that?  What  would  you  do  for  it? 

A.  I should  give  the  treatment  for  the  general  sj'Stem  first:  we  must  get 
rid  of  what  is  causing  it,  whether  it  be  impurities  in  the  blood  or  a scrofulous 
condition,  or  anything  of  that  kind.  Any  case  would  depend  upon  general 
causes  to  some  extent,  and  you  would  have  to  give  a general  treatment  to 
purify  the  blood.  That  is,  attend  to  all  the  avenues  of  secretion  and  excretion 
and  of  assimilation  and  nutrition  in  general.  The  local  treatment  would  then 
be  confined  to  loosening  all  the  parts  and  freeing  the  blood  and  nerve  supply  to 
the  organs  affected. 

Q.  Please  give  the  treatment  for  reduction  of  fevers. 

A.  In  the  first  place  it  is  said  that  when  there  is  fever  in  the  body  that  it 
is  made  by  the  refuse  not  being  cast  off,  and  hence  being  burned.  Nature  is 
making  an  extra  effort  to  burn  the  refuse,  and  hence  is  causing  a fever.  Wheth- 


200 


er  that  be  true  or  not,  you  know  that  there  is  in  many  cases  almost  a complete 
suppression  of  urine  in  fever,  or  if  not  so  much  as  that,  that  the  urine  is 
scanty  and  hi^h  colored.  You  must  go  to  the  kidneys  and  free  their  action. 
Go  also  to  the  bowels  and  free  their  action;  combine  the  general  treatment. 
Look  for  the  cause ; of  course  it  vvould  depend  upon  what  kind  of  fever  it  was ; 
and  then  having  treated  the  particular  cause,  the  Osteopath  also  goes  to  the 
superior  cervical  ganglion  and  inhibits  the  action  of  the  heart.  You  can  in- 
hibit the  superior  cervical  ganglion  either  opposite  the  transverse  processes  or 
in  the  sub-oecipital  fosste.  Then  give  the  treatment  in  the  upper  dorsal  region, 
stimulating  the  action  of  the  lungs  to  help  them  to  carry  off  the  poisonous  mat- 
ter in  the  body.  Also  treat  the  splauchuies.  In  general,  go  to  the  cause.  I 
suppose  you  have  heard  Dr.  Still’s  theory  of  fever — he  says  that  the  lung  is 
not  acting  properly,  that  the  gases  are  not  properly  condensed,  and  he  treats 
fevers  through  the  lung  a good  deal,  to  get  it  to  act  properly  that  the  poisons 
of  the  body  may  be  excreted  properly. 

Q.  Would  you  treat  the  vagi  in  fever? 

A.  Yes,  sir,  we  would  treat  them  for  the  general  effect  on  the  liver  and 
intestines,  and  you  could  stimulate  them  to  inhibit  the  pulse.  Of  course  you 
have  not  cured  the  fever  simply  by  slowing  the  heart,  that  is  an  adjuvant.  You 
must  go  to  the  first  cause;  having  done  that  work  I should  also  go  to  the 
splanchnics,  as  I have  said,  and  should  inhibit  there ; having  inhibited  the  cer- 
vical, I would  inhibit  in  the  middle  dorsal  region  or  along  the  splanchnics  and 
then  I would  go  to  the  fifth  lumbar,  where  you  get  the  center  for  the  hypogas- 
tric plexus  and  through  it  the  pelvic  plexuses.  Tour  object  in  doing  that  is  to 
dilate  the  vessels,  and  thus  inhibit  the  vaso-constrietors  and  stimulate  the  vaso- 
dilators, or  you  tend  to  restore  things  to  the  normal.  In  other  words,  you 
free  the  body,  free  the  parts  affected,  and  dilate  the  abdominal  veins.  In  that 
way  you  equalize  the  circulation.  That  is  just  part  of  your  general  work,  and 
it  depends  on  the  kind  of  fever ; in  typhoid  fever  you  have  to  go  to  the  intes- 
tines and  treat  them. 

Q.  How  do  you  treat  chills? 

A.  Stimulate  the  heart  to  propel  the  blood  faster  ; stimulate  the  lungs  so 
that  the  blood  will  be  better  purified. 

Q.  Where  the  fever  follows  the  chill  as  soon  as  it  is  over,  would  you  be- 
gin treatment  for  the  fever  at  once? 

A.  If  I supposed  it  would  come  on  right  away  ; I would  be  on  the  watch 
for  it ; I do  not  know  that  I would  begin  to  treat  immediately.  But  having 
taken  those  general  points  together,  I would  also  combine  with  that  general 
spinal  treatment  and  treatment  for  the  heart,  a general  stimulating  treatment, 
and  in  some  cases  it  might  not  hurt  to  stretch  the  limbs,  and  do  all  you  can  to 
stimulate  the  flow  of  blood  through  the  body.  In  chills  and  fever  treat  espec- 
ially the  liver  and  spleen. 


201 


Q.  Just  about  what  you  would  do  for  a cold  or  la  grippe? 

A.  Largely  so  in  that  general  treatment.  Then  they  say  that  rapid  rub- 
bing upward  along  the  spine,  hard  and  quickly,  will  cause  a chill  to  cease.  On 
one  of  the  hot  days  last  summer  I was  called  to  a case;  it  was  not  a regular 
chill,  hut  the  person  had  become  over-heated,  and  the  blood  had  left  the  sur- 
face of  the  body.  He  felt  extremely  faint,  had  dilficultv  in  standing  up,  and 
was  covered  with  a cold,  clammy  perspiration  ; the  surface  of  the  body  was 
chilly.  I immediately  stimulated  the  heart  and  lungs,  inhibited  at  the  superior 
cervical,  and  gave  a general  treatment  to  equalize  the  blood  and  keep  it  circu- 
lating. 1 had  the  patient  keep  quiet  and  he  soon  felt  all  right. 

Q.  I would  like  to  know  what  treatment  you  would  give  for  vaso-dilator 
effect  and  for  vaso-constrictor  effect,  to  inhibit  the  flow  of  blood  or  increase  it. 

A.  I do  not  know  that  I would  give  any  in  that  way.  For  instance,  go 
to  the  splanchnics,  they  contain  both  vaso-dilators  and  vaso-constrictors,  go 
to  the  sciatics,  they  also  contain  both.  JlTow,  I cannot  treat  the  sciatic  or  the 
splanchnics  and  cause  that  particular  set  of  fibers  to  act  alone,  that  is,  I do 
not  know  that  I can,  and  frequently  I emiiloy  a method  which  I say  will  in  - 
hibit  and  frequently  do  that  which  we  say  will  stimulate,  and  no  doubt  we 
do  so.  As  near  as  I can  describe  it  to  you,  a treatment  to  stimulate,  and  a 
holding  pressure  over  the  root  of  the  nerve  will  inhibit.  It  is  very  hard  to 
say  just  what  we  do  there,  I tend  more  and  more  to  the  belief  that  we  simply 
restore  something  that  is  abnormal  to  the  normal  conditions,  and  allow  natui-e 
to  do  the  rest.  I think  that  is  the  best  theory  by  which  we  can  explain  so 
many  things,  and  there  are  many  things  we  cannot  explain  by  the  theory  of 
stimulation  and  inhibition. 

Q.  If  a person  faints  from  overheating,  is  not  there  any  si^ecial  treat- 
ment besides  holding  the  head  down.  Dr.  Charley  Still  seems  to  have  had 
good  results  in  that  trouble? 

A.  In  such  a case  you  would  also  have  to  direct  your  attention  to  the  geu- 
eral  condition.  In  case  of  overheating,  where  there  is  an  inward  congestion, 
very  likely  the  blood  is  prevented  from  flowing  to  the  head  and  is  congested 
about  the  lungs  particularly,  and  about  the  intestines,  since  there  the  veins  di- 
late the  most  readily  and  hold  the  most  blood.  You  would  have  to  apply  your 
stimulating  treatment,  and  cause  the  blood  to  circulate  freely. 

Q.  I would  like  to  know  why  it  is  that  nervous  prostrations  is  so  much 
more  a general  complaint  of  ladies  than  gentlemen,  and  what  treatment  yon 
would  advise. 

A-.  Nervous  prostration  is  a very  serious  thing.  Whenever  I can.  1 ad- 
vise against  studying  too  hard  and  too  long  at  a time,  according  to  the  patient's 
constitution,  of  course.  A person  can  stand  only  a certain  amount  of  work  at 
a time.  For  myself  I make  it  a rule  not  to  work  extremely  hard  longer  than 
two  or  three  hours  at  a time.  I can  work  four  hours  or  more  at  a time,  but  I 


202 


do  not  do  it  often,  I do  it  when  it  is  necessary.  In  iny  regular  work  wliere  I 
can  regulate  my  hours,  I will  have  something  to  break  in  at  the  end  of  about 
two  hours.  It  is  a question  of  personal  expereuce  and  personal  taste,  although 
one  may  work  too  long  and  too  hard.  I have  seen  a number  of  cases  of  ner- 
vous break  down  from  over  study,  I have  seen  them  in  college,  and  I do  not  want 
auy  iu  mine.  It  is  caused  by  lack  of  exercise,  lack  of  fresh  air,  sedentary  hab- 
its, too  much  stimulants,  as  tea  or  coffee,  and  two  much  of  a strain  on  the  men- 
tal faculties.  To  prevent  that,  the  prophylactic  treatment  would  be  to  regulate 
the  habits  of  the  patient  as  far  as  possible,  get  them  to  take  plenty  of  exercise, 
etc.,  because  when  the  trouble  has  once  come  on,  it  is  in  the  majority  of  cases 
hard  to  get  over,  and  almost  always  leaves  its  effects.  And  then  as  to  our 
Osteopathic  treatment,  the  treatment  will  have  to  be  general,  since  the  nervous 
organism  is  exhausted,  you  will  have  to  generally  tone  it  up,  and  it  will  take 
considerable  time  and  general  treatment. 

Q.  Give  us  the  treatment  for  diphtheria. 

A.  Diphtheria  of  course  is  a constitutional  trouble,  and  when  a patient  is 
sick  with  it,  he  is  sick  all  over.  You  will  have  to  prevent  the  membrane  form- 
ing if  possible,  and  that  can  be  done  very  nicely.  Dr.  Charley  Still  has  had  the 
very  best  experience,  more  than  any  other  Osteopath,  he  had  a remarkable  run 
of  cases  in  Red  Wing,  Minnesota,  and  had  remarkable  success.  His  treatment 
was  very  largely  about  the  neck  and  throat,  he  would  treat  there  to  keep  the 
blood  supply  open,  you  know  how  to  do  it,  free  all  the  muscles  and  ligaments, 
and  especially  keep  the  anterior  muscles  softened  and  loose  so  that  there  can  be 
no  tension  there  and  any  stoppage  of  the  blood  so  that  an  excretion  can  grow  in 
the  throat  and  form  a membrane.  You  must  attend  to  the  bowels  and  the  kid- 
neys and  the  general  health. 

Q.  When  the  membrane  does  form  what  do  you  do? 

A.  To  cause  the  patient  to  yomit  is  one  way,  in  order  to  throw  it  out,  and 
there  are  certain  drinks  that  they  use  to  loosen  the  membrane. 

Q.  How  often  should  you  treat  in  diphtheria? 

A.  Dr.  Charley  Still  said  that  he  frequently  would  come  back  to  a case 
jnside  of  fifteen  or  twenty  minutes.  He  was  unprotected  by  the  law  and  he  had 
to  go  very  carefully  or  he  would  have  had  trouble. 

Q.  Did  he  treat  for  the  fever? 

A.  Yes,  you  would  have  to  treat  for  that  according  to  the  treatment  out- 
lined. 

Q.  In  any  acute  trouble  of  that  kind  would  you  just  treat  for  the  symp- 
toms you  see,  unless  you  hud  some  lesion? 

A.  No,  sir,  that  is  hardly  our  method,  we  should  try  to  find  a lesion,  in 
the  spine  particularly,  and  you  would  probably  be  successful. 

Q.  Suppose  you  did  not  find  a lesion? 

A.  If  you  didn’t  find  a lesion  you  could  only  go  according  to  principles  and 


203 


work  on  the  centers  indicated,  but  you  will  liud  lesions  or  contracted  muscles, 
or  something  of  that  kind. 

Q.  Give  the  treatment  for  granulated  eyelids. 

A.  In  granulated  eyelids,  first,  of  course,  you  must  turn  back  the  lids 
and  examine  whether  or  not  the  granulations  be  there.  Usually  there  is  con- 
siderable stretching  and  irritation  and  the  eyeball  is  inflamed,  then  you  will  see 
the  granulations  existing  as  little  white  points  all  along  on  the  inside  of  the  lid. 
3mu  may  find  them  on  both  lids.  Our  treatment  tnere  localU  is.  after  having 
wet  the  finger  with  a little  soap  suds,  or  having  vaseline  on  it,  to  gently  work 
all  along  under  the  edge  of  both  lids  and  to  rub  on  the  outside  of  the  lids  as  you 
go  along ; that  will  crush  the  gradulations.  Some  say  that  the  granulations 
are  caused  by  the  stoppage  of  the  ducts  of  the  Meibomian  glands.  -‘Old  Doc- 
tor,” however,  says  that  there  is  some  obstruction  to  the  veins,  that  the  blood 
is  brought  to  the  eye  and  cannot  get  away,  consecpiently  it  must  do  something, 
and  it  goes  to  work  then  to  build  up  some  foreign  growth.  That  seems  to  be 
the  most  reasonable  theory.  If  you  want  to  know  particularly  about  granulated 
eyelids,  ask  Dr.  Hildreth;  he  had  quite  a remarkable  case,  which  the  “Old  Doc- 
tor” cured.  Having  treated  the  gi’anulatious,  treat  the  points  of  the  fifth  nerve 
over  the  eye  here,  on  the  forehead,  at  the  inner  and  outer  canthus  of  the  eye. 
and  at  the  supra  and  infraorbital  foramina,  to  free  the  blood  flow.  Treat  par- 
ticularly through  the  upper  cervical  region,  and  look  for  any  lesion  in  the  cervi- 
cal legion  ; give  the  general  treatment  for  the  neck  in  order  to  keep  the  blood 
supply  freely  open  to  the  eye. 

Q.  Where  the  upper  lid  is  drooping,  would  you  give  the  same  treatment? 

A.  I would  there  stimulate  the  flow  of  blood  and  would  stimulate  the  fifth 
nerve,  since  it  is  the  muscular  trouble,  and  you  must  tone  up  the  muscles  and 
and  strive  to  get  them  built  up  through  the  blood  flow. 

Q.  Do  you  give  the  same  treatment  for  cataract? 

A.  A^ou  would  treat  particular  through  the  fifth  nerve  for  cataract,  as 
the  fifth  nerve  has  to  do  with  nutrition  of  the  ej^e,  particularly  its  anterior 
part.  You  reach  it  through  the  superior  cervical,  at  the  inferior  maxillaiy 
articulation,  and  through  these  points  that  1 have  mentioned  over  the  face. 
Also  look  for  any  lesion  in  the  cervical  region  or  in  the  upper  dorsal.  Give  the 
general  treatment  of  the  neck. 

Q.  In  case  of  the  eyeball  turning  inward,  for  instance  the  right  one, 
through  weakness  of  either  the  external  muscles  or  increased  strength  of  the 
other  muscles,  what  do  you  do? 

A.  I do  not  know  .just  what  the  experience  has  been  in  regard  to  crossed 
eyes.  However,  I have  known  of  cases  being  treated  surgicall.v,  which  is  alwaj’s 
to  cut  a few  fibers  of  the  muscle  which  is  opposite  to  the  one  affecting  the  e,ve 
most — on  the  side  pulling  the  most  stronglj'’;  that  weakens  that  muscle  and  al- 
low's  its  antagonist  to  be  more  evenly  balanced  in  its  action.  That  will  allow 


204 


the  eye  to  become  straight.  But  the  trouble  with  that  oi3eration  is  that  after 
the  person  has  gotten  well  and  the  general  health  has  increased,  this  weak  mus. 
ele,  if  the  trouble  was  of  this  muscle,  will  strengthen  and  pull  too  hard  against 
the  one  which  has  been  weakened  by  the  operation.  I have  heard  of  such  cases. 
In  speaking  of  such  troubles  once  before  I asked  Dr.  Sheehan  if  he  had  met 
such  cases  and  he  said  he  had,  where  the  cure  was  only  temporary  from  that 
surgical  operation,  and  the  trouble  returned.  The  treatment  there  0.steopathi- 
cally  would  be  to  strengthen  the  muscles.  I have  heard  of  a number  of  cases 
being  treated.  However,  in  cases  of  young  children  I think  they  are  successful. 

Q.  This  is  a case  of  a party  about  middle  age  and  it  came  on  suddenly. 

A.  I w^ould  by  all  means  try  it  in  all  such  cases;  where  it  comes  on 
suddenly  that  way  it  may  be  a nervous  trouble,  it  may  be  a slip  in  the  neck 
somewhere.  I would  not  send  the  patient  away  and  say  I could  not  cure 
him,  not  unless  I was  positive.  It  is  pretty  hard  to  be  certain.  In  some 
cases  the  Osteopath  can  not  tell  until  he  has  tried,  and  if  he  is  conscientious 
he  must  treat  his  ijatients  aw'hile  before  he  is  sure. 

Q.  How'  would  you  treat  for  pneumonia? 

A.  In  pneumonia  the  trouble  is  in  the  lungs,  and  pneumonia  is  usually 
handled  very  nicely.  The  iDatient  will  usually  have  fever  besides  the  trouble 
of  the  lungs.  The  simple  osteopathic  treatment  is  to  stimulate  the  lungs,  as 
I have  shown,  in  the  upper  dorsal  region  all  along  on  both  sides.  Find  out 
particularly  which  one  is  affected  by  the  methods  which  I have  shown  you. 
Treat  for  the  fever-  In  children  and  old  people  it  often  follows  measles  or  is 
a complication  of  them,  and  if  you  are  called  to  a case  of  measles  do  not  for- 
get that  complication;  in  all  cases  look  out  for  pneumonia. 

Q.  Is  there  any  w^ay  in  which  severe  coughing  can  be  stopped  imme- 
diately? 

A.  It  will  depend  upon  the  cause  of  the  trouble.  If  I were  called  to 
such  a case  about  the  first  thing  I would  do  would  be  to  examine  the  pneu- 
mogastrics  to  see  whether  or  not  there  was  some  irritation  in  the  neck  affect- 
ing them.  Or  if  I could  not  find  it  I would  inhibit  the  action  of  the  iineumo- 
gastrics.  There  are  laryngeal  branches  supplying  the  larynx  which  may  be 
irritated  causing  severe  coughing.  It  may  be  some  irritation  of  the  pneumo- 
gastric  in  the  stomach  that  is  irritating  the  nerves  and  causing  the  coughing. 

Q.  What  would  you  do  when  it  is  caused  from  the  lungs? 

A.  I would  give  a general  treatment  to  the  lungs.  I would  go  to  the 
lungs  first  and  treat  them. 

Q-  In  case  the  heart  ceases  to  beat  for  a short  time,  say  during  sleeji, 
and  the  person  awakens  and  cannot  breath  until  he  has  got  on  his  feet 
or  something  of  that  kind,  what  would  you  do? 

A.  I would  raise  the  ribs  on  the  left  side.  I would  draw  the  arm  back 
strongly  while  holding  my  other  hand  in  a V shape  under  the  angles  of  the 


205 


ribs.  What  you  describe  is  probably  some  palpitation  and  may  be  nervous 
in  cause.  Perhaps  the  patient  has  lain  upon  the  back  for  a certain  length  of 
time  and  has  turned  in  his  sleep  and  gotten  two  ribs  compressed  together. 
The  idea  there  is  that  you  give  the  heart  more  room  mechanically,  by  raising 
the  ribs,  and  that  you  stimulate  the  splanchnics  along  the  spine  which  we 
reach  along  the  upper  dorsal. 

Q.  Give  the  treatment  for  rheumatism. 

A.  There  are  several  kinds  of  rheumatism.  In  any  case  we  go  to  the 
kidneys,  we  treat  them  always  in  the  manner  shown,  to  free  the  system  of 
the  acid  which  frequently  is  present  in  a ease  of  rheumatism.  Sometimes 
acute  rheumatism  comes  on  without  any  other  previous  form,  that  is,  it  be- 
gins as  articular  rheumatism,  and  will  strike  one  joint,  say  the  shoulder,  and 
next  it  will  be  in  the  knee  of  the  opposite  limb,  the  following  day  it  will  be  in 
the  forearm,  then  in  the  wrist,  and  it  jumps  about  from  place  to  place.  In  such 
a case  we  would  stretch  the  joint,  separate  it.  I would  also  for  this  shoulder 
work  along  the  dorsal  region,  loosening  the  muscles  there,  any  contraction; 
then  I would  stimulate  at  the  origin  of  the  brachial  plexus,  along  the  scaleni 
muscles,  between  which  the  branches  of  the  jjlexus  run  out  to  the  arm; 
raise  the  clavicle,  stimulate  the  subclavian  artery,  and  in  general,  thoroughly 
relax  everything  about  that  arm  and  free  the  forces  of  life  to  it.  I would  do 
that  for  auy  joint  affected.  In  case  of  muscular  rheumatism  you  must  treat 
very  gently,  treat  the  blood  and  nerve  supply  to  the  part  and  work  over  the 
muscles  affected  very  gently,  that  is,  bring  gentle  pressure  and  stretch  them 
very  gently.  I have  known  of  a case  of  general  muscular  rheumatism  where 
we  simply  went  over  the  patient,  gave  him  a gentle  treatment,  stretched  the 
muscles  and  the  ligaments  and  stimulated  the  kidneys  and  the  liver  and  the 
general  excretory  organs. 

Q.  What  is  the  treatment  for  flux? 

A.  The  same  as  for  diarrhea,  I believe  I showed  that  at  one  time.  The 
chief  thing  which  we  do  is  to  work  strongly  along  the  lumbar  region,  spring 
the  spine  strongly,  and  hold  against  it.  I have  seen  cases  treated  in  that 
way,  just  as  you  see  me  doing  here,  the  point  of  the  knees  against  you  here, 
and  hold  against  the  eleventh  and  twelfth  ribs,  inhibiting  the  action  of  the 
nerves  there  to  stop  the  rapid  peristalsis,  that  is  the  theory.  You  can  do 
that  by  setting  the  patient  upon  a chair,  get  your  knee  against  the  heads  of 
the  eleventh  and  twelfth  ribs,  and  pull  the  arms  up  and  out,  and  you  thus 
get  a strong  pressure  against  this  point.  I would  also  stimulate  the  flow  of 
bile.  I described  to  you  not  long  ago  a case  of  flux  of  long  standing;  in  that 
case  I found  that  the  two  lower  ribs  were  too  close  together  on  each  side,  and 
that  there  was  a contraction  and  smoothness  along  the  lower  lumbar  region. 
I relaxed  that  and  straightened  the  ribs,  and  it  took  but  two  treatments  to 
cure  the  case. 


20G 


Q.  Please  give  the  treatment  for  catarrh. 

A.  That  is  general  treatment  of  the  neck,  and  is  what  I have  already 
given,  but  I might  mention  a few  points.  They  say  always  that  there  is  a 
tender  place  under  the  angle  of  the  jaw.  It  will  hardly  be  necessary  for  me 
to  show  you  all  these  motions.  The  theory  there  is  that  some  contraction, 
either  recent  or  of  long  standing,  is  shutting  off  the  blood  supply  to  the 
membranes  of  the  throat  and  nose. 

Q.  Do  you  treat  in  the  mouth"? 

A.  We  sometimes  treat  through  the  mouth.  You  can  put  the  finger 
back  and  work  from  the  top  of  the  palate  down  along  the  pillars  of  the  fauces 
on  each  side;  we  sometimes  do  that. 

Q.  How  would  you  treat  a sprained  ankle  or  knee? 

A.  Say  it  was  the  knee,  you  must  be  very  careful,  if  it  is  a recent  case 
and  there  is  swelling  about  it  you  must  take  the  swelling  down.  I would  not 
move  the  member  much  at  first,  and  the  best  way  that  I know  to  reduce  a 
congested  condition  from  inttammation  after  severe  strain  is  the  use  of  hot 
water,  hot  bandages  or  the  hot  water  bottle,  or  something  of  that  kind.  After 
having  reduced  the  swelling  you  can  see  if  the  parts  are  dislocated,  examine 
to  see  if  they  are  out  of  place  or  if  there  is  any  break.  Of  course  if  you  are 
called  at  once  to  the  case  you  can  find  that  out  at  once.  You  should  always 
do  that  as  early  as  possible,  find  out  if  there  are  any  dislocated  parts,  and  if 
there  are  you  must  put  them  back  as  soon  as  possible.  If  there  are  no 
broken  or  dislocated  parts,  after  having  taken  down  the  swelling  principally 
by  the  use  of  hot  applications,  I would  work  gently  at  the  popliteal  space  to 
relax  the  muscles  and  stimulate  the  popliteal  vessels,  then  I would  bend  the 
thigh  up  and  stretch  the  muscles  about  the  saphenous  opening  to  allow  the 
blood  flow  above  to  be  properly  opened,  and  give  the  stretching  motion  to  the 
leg  to  relax  its  muscles  in  general.  I should  then  treat  along  the  lower  part 
of  the  spine,  especially  where  we  reach  the  sacral  plexus,  so  as  to  stimulate 
the  nerves  to  the  leg. 

Q.  Those  movements  would  be  rather  painful,  would  they  not? 

A.  You  will  have  to  be  very  careful,  perhaps  you  cannot  do  them  at 
first.  I have  had  cases  of  sprain  where  I would  not  manipulate  at  all  for 
several  days;  I just  used  the  hot  applications  about  it,  and  watched  to  see 
that  no  trouble  took  place,  but  it  was  several  days  before  I began  to  manipu- 
late. At  first  you  can  treat  the  lower  part  of  the  spine  without  moving  the 
leg,  and  I would  do  that.  In  these  cases  I have  had  good  success.  Some- 
times your  strain  will  not  be  painful,  and  you  can  manipulate  the  leg  from 
the  start;  it  depends  altogether  on  the  conditions. 

Q.  Has  Osteopathy  come  in  contact  with  yellow  fever  or  cholera,  and  if 
so,  with  what  success? 

A.  The  “Old  Doctor”  says  he  has  treated  cholera.  I do  not  know  that 


207 


we  liave  ever  liiid  any  cases  of  yellow  fever.  About  all  I know  about  the  treat- 
ment for  cholera  is  that  Dr.  Still  says  he  treated  the  lungs,  he  was  speaking 
on  that  the  other  day  in  relation  to  his  theory  of  the  formation  of  gases  in  the 
lungs,  and  also  stimulated  the  excretions. 

Q.  What  is  the  treatrnent  in  Bright’s  disease? 

A.  In  Bright’s  disease  treat  for  the  kidney.  Bright’s  disease  is  a gen- 
eral name.  However,  it  refers  to  a disease  of  the  parenchyma  of  the  kidney, 
and  there  are  various  forms.  You  would  have  to  look  for  any  lesion  affect- 
ing the  kidney  along  the  lower  dorsal  region  or  at  the  second  lumbar,  and 
your  idea  there  would  be  to  work  upon  the  nerve  supjjly  to  the  kidney  by 
treating  over  the  spine.  Then  you  could  work  at  the  umbilicus,  as  I have 
shown  you,  to  get  these  centers,  or  you  can  reach  them  by  deep  pressure  over 
the  renal  ganglia,  which  lie  on  the  renal  arteries. 

Q.  How  do  you  regulate  the  action  of  the  kidneys  when  they  are  acting 
too  frequently? 

A.  When  the  kidneys  aie  acting  excessively  or  too  frequently,  the  idea 
is  that  you  must  find  any  lesion  which  may  cause  an  irritation  or  inhibition 
of  the  nerve  force.  It  is  frequently  confined  to  about  what  I have  said,  to 
look  for  the  lesion  and  remove  it,  and  then  treat  along  the  region  of  the  spine 
where  we  get  the  nerves  to  the  kidneys. 

P.  Stimulate  to  increase  the  action,  and  inhibit  to  lessen  it? 

A.  Well,  that  brings  us  back  to  the  question  of  just  what  we  do  when 
we  stimulate  or  inhibit.  It  would  depend  upon  the  condition  there  whether 
I would  spring  the  spine  and  work  in  such  a way  as  to  stimulate  or  whether 
I would  hold. 

Q.  If  there  was  too  much  secretion  you  would  not  treat  in  the  same  way 
as  if  you  wanted  to  increase  it? 

A.  I would  be  very  likelj^  to.  I would  stimulate  along  the  region  of 
the  spine  which  shows  there  is  some  obstruction  to  the  nerve  force  and  my 
idea  would  be  to  remove  that  obstruction. 

Q.  Woiild  you  xjull  on  the  neck  when  it  is  turned  to  one  side  or  the 
other  and  turn  it? 

A.  1 would  not  i)ull  it  and  turn  it. 

Q.  I mean  after  it  is  turned. 

A.  O,  yes;  I would  not  be  afraid  to  do  that.  I would  have  the  neck 
turned  about  in  this  way,  and  this  straight  pull  is  about  the  best  way,  but  I 
would  not  i)ull  it  and  turn  it,  because  you  are  likely  to  cause  trouble.  The 
parts  are  more  aj^t  to  be  stretched,  and  you  may  get  an  articular  x)rocess  out 
of  place. 

Q.  In  varicose  veins,  what  would  you  do  other  than  mauixiulate  the 
nerves  and  the  limbs? 

A.  I wonld  work  along  the  lower  region  of  the  spine,  and  stimulate  the 


208 


sacral  nerves,  and  I would  stretch  the  leg  thoroughly,  and  stimulate  the 
sciatic,  since  the  sciatic  contains  the  vaso-niotor  nerves  for  the  limbs;  then  at 
the  saphenous  opening,  I would  loosen  that  as  I have  already  told  you  how 
to  do,  and  I would  work  upwai’d  from  the  varicose  veins  along  the  course,  of 
the  veins  to  stimulate  the  flow  of  blood.  Do  everything  to  build  up  the  tone 
of  the  limb.  The  trouble  may  be  somewhere  else,  but  it  is  most  frequently  in 
the  legs,  from  standing  on  the  feet  too  much. 

Q.  How  would  you  treat  neuralgia  of  the  heart’? 

A.  I would  confine  myself  there  to  the  upijer  dorsal  region.  I would 
go  to  that  region  first  and  would  give  the  heart  all  the  room  to  play  in  that 
it  needed,  then  I would  inhibit  at  the  superior  cervical  region  with  the  idea 
of  inhibiting  the  nerve  force  and  quieting  the  spasm  if  possible.  You  can  do 
anything  to  reach  the  nerve  force  and  quiet  it.  It  is  evidently  excited  and 
there  is  evidently  some  irritation.  Your  idea  is  to  find  the  cause  of  the  ir- 
ritation and  remove  it  if  possible.  It  may  be  caused  by  some  iroison  in  the 
system,  then  you  would  have  to  remove  the  original  cause  by  general  treat- 
ment. Dr.  McConnell  says  the  trouble  is  frequently  in  the  costal  cax’tilages. 

Q.  How  would  you  treat  cerebral  troubles? 

A.  Through  the  neck,  it  depends  upon  the  ease,  of  course. 

Q.  In  hay  fever  would  the  treatment  be  anything  different  from  that  for 
general  fevers? 

A.  Yes,  look  for  the  lesion  in  the  superior  cervical  region  or  in  the  upper 
dorsal,  sometimes  the  first  rib  is  at  fault,  sometimes  the  clavicle,  and  you 
must  look  for  the  lesion  in  those  places.  ^Ye  do  not  have  the  ordinary  symp- 
toms of  fever  in  hay  fever,  it  is  a catarrh. 

Q.  How  would  you  treat  for  lumbago? 

A.  I would  relax  everything  along  the  spine,  especially  in  the  lower 
part;  first  by  working  the  muscles,  then  by  flexing  the  knees  against  me,  then 
I would  put  the  patient  into  a chair  and  lift  up  and  turn  as  I lifted.  I think 
the  theory  is  that  the  tension  of  the  ligaments  there  is  affecting  the  nerves 
and  causing  the  stiffness  of  the  muscles,  I have  seen  several  cases  treated  in 
that  way  and  very  successfully. 

Q.  How  would  you  treat  appoplexy? 

A.  It  depends  upon  general  causes  and  conditions  generally.  That  is, 
it  generally  occurs  in  elderly  people,  where  they  are  not  used  to  much  exer- 
cise and  after  they  have  run  for  a train  or  to  a fire,  they  get  their  hearts  ex- 
cited and  their  vessels  being  weak  and  the  general  tone  of  their  system  being 
relaxed,  there  is  a break  of  a small  capillary  in  the  brain  and  the  formation  of 
a clot,  and  perhaps  it  does  not  extend  farther  than  congestion  of  the  brain. 
Sometimes  it  is  in  cases  of  people  who  have  long  been  bothered  with  conges- 
tion, and  the  blood  does  not  circulate  properly  through  the  brain  or  the  body, 
and  too  much  is  thrown  to  the  head.  You  would  have  to  relieve  the  general 


209 


causes,  and  you  must  in  some  way  call  the  overplus  of  blood  from  the  head, 
and  in  that  case  you  would  treat  over  the  suiDerior  cervical  region  ijarticu- 
larly,  and  then  to  get  your  effect  you  would  have  to  work  over  the  solar 
plexus  and  the  splanchnics  to  draw  the  blood  from  the  head.  That  in  general 
is  the  treatment.  Of  course  you  understand  these  are  just  snap  shots.  I can- 
not say  much  on  any  of  these  subjects  here.  What  I have  said  is  simply  as 
far  as  my  knowledge  has  gone. 

Q.  Is  catarrhal  fever  treated  the  same  as  catarrh? 

A.  Well,  hardly,  you  would  have  to  go  further  than  the  general  treat- 
ment for  catarrh.  Catarrhal  fever  is  a name  ai^plied  to  catarrh  when  it  has 
extended  to  the  stomach,  and  you  have  a bilious  fever  or  gastric  fever.  You 
must  work  then  for  the  nerve  centers  for  the  stomach,  and  thoroughly  free 
them  up.  I have  had  a case  of  that  and  had  very  goad  success  with  it.  They 
usually  have  a stitch  in  the  side.  I do  not  know  what  causes  it,  that  is  one 
of  the  symptoms.  My  treatment  was  to  stimulate  the  stomach  and  intestines 
in  all  parts  and  work  through  the  superior  cervical  region. 


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